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An underlying condition is a second condition that you may have in addition to the first diagnosed condition, and this underlying condition is believed to cause the first condition. In this case, the underlying condition is the true primary condition, since it occurred first, and the originally diagnosed condition is actually called the "secondary" condition.
Example: Hemochromatosis underlying diabetes: For example, most people diagnosed with diabetes have only that disease, but in a small percentage the diabetes is actually caused by a second underly condition called hemochromatosis. The hemochromatosis is called the underlying condition, and the diabetes is actually called secondary diabetes, because the real primary condition is hemochromatosis and the diabetes is a secondary complication of the primary disease.
Example: Metabolic syndrome or PCOS underlying obesity: As another example, people who have the condition of obesity or being overweight might simply have poor lifestyle habits. On the other hand, they might have an underlying condition such as metabolic syndrome or polycystic ovary syndrome (women only).
Misdiagnosis of underlying conditions: Failure to diagnose an underlying condition is a reasonably common occurrence and represents a partial misdiagnosis. In some cases, the misdiagnosis is critically important (hemochromatosis-caused diabetes is curable), and in other cases it is less so: a full diagnosis of underlying metabolic syndrome does not necessarily help treat obesity, though it makes it more important to watch out for other conditions and risk factors for heart disease.
In a sense, the issue of underlying conditions is really just a generalization of the disease-symptom pattern. The underlying condition has the first disease as one of its symptoms or complications.
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