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Tiredness/fatigue in adults - Management
When should I refer an adult with tiredness?

  • Referral to secondary care is likely to be required if a serious underlying physical cause is suspected or identified, such as Addison's disease, coeliac disease, HIV, hepatitis B or C, malignancy, renal failure, or sleep apnoea (see the CKS topic on Sleep apnoea).
  • Refer adults (18 years of age or older) with symptoms suggestive of chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy (CFS/ME) to specialist CFS/ME services:
    • Within 6 months of presentation, if symptoms are mild.
    • Within 3–4 months of presentation, if symptoms are moderate.
    • Immediately, if symptoms are severe.
  • Consider referring to secondary care those people with persistent, unexplained tiredness/fatigue not meeting the criteria for CFS/ME if any of the following apply:
    • There is significant uncertainty regarding the presence of an underlying physical cause.
    • The person would benefit from the reassurance of a second opinion or from the thoroughness of a secondary care evaluation, and referral is not likely to reinforce unrealistic beliefs in a physical cause.
    • The person may benefit from access to the structured and multidisciplinary care delivered by specialist CFS/ME services, or from a secondary care opinion for occupational reasons or disability benefits.
  • Children and young people 17 years of age or younger should be referred to paediatrics within 6 weeks of presentation, but are not included in the scope of this topic.

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