Physical signs

• loss of muscle mass
• dry skin
• brittle hair and nails
• callused skin over interphalangeal joints (Russell sign)
• anaemia
• hypercarotinaemia (yellow skin and sclera)
• fine, downy, lanugo body hair
• eroded tooth enamel
• peripheral cyanosis
• hypotension
• bradycardia
• hypothermia
• atrophy of the breasts
• swelling of the parotid and submandibular glands
• swollen tender abdomen (intestinal dilatation due to reduced motility and constipation)
• peripheral neuropathy

Psychiatric symptoms

• Concentration/memory/decision-making problems
• Irritability
• Depression
• Low self-esteem
• Loss of appetite
• Reduced energy
• Insomnia
• Loss of libido
• Social withdrawal
• Obsessiveness regarding food
• General physical health concerns
• Amenorrhoea
• Cold hands and feet
• Weight loss
• Constipation
• Dry skin
• Hair loss
• Headaches
• Fainting or dizziness
• Lethargy