Cheryl, 46, presents with worsening fatigue for the past few months.

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<p>Cheryl, 46, presents with worsening fatigue for the past few months. She is usually well, takes no medications and does not drink or smoke.</p><p>Her menses have been heavier and more frequent over the past year, which she attributes to known fibroids and perimenopause.</p><p>Oddly, she has been craving brussel sprouts and pumpkin and has been including these in most meals for months.</p><p>On examination, Cheryl has a tachycardia of 110bpm at rest; her vital signs are otherwise normal, and her BMI is stable at 21kg/m2. Palmar discolouration is noted (pictured), with the nasolabial folds and soles also affected.</p><p>She has pale conjunctivae but no scleral icterus. Examination is otherwise normal.</p><p>Pathology is significant for iron-deficiency anaemia. Beta-human chorionic gondatropin, coeliac serology and FOBT are negative.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.