Hot Flashes

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of hot flashes

Severity is ‍mildmoderatesevere

Lasts for ‍ ‍secminhours

Occurs ‍ times per ‍hoursdaysweeksmonths

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍sleep disturbances

‍night sweats

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍dizziness

‍cold sweats

‍irritability

‍mood swings

‍decreased concentration

‍vaginal dryness

‍decreased sex drive

last menstrual period: ‍ ‍daysweeksmonths ago



Contributing factors:

‍smoking

‍obesity

‍lack of physical activity

menopause since ‍

no history of: ‍breast cancer, ‍ovarian failure, ‍hyperthyroidism, ‍pheochromocytoma, ‍carcinoid syndrome, ‍oophorectomy

no use of: ‍antiestrogens, ‍SSRIs, ‍tricyclic antidepressants, ‍oral contraceptive, ‍hormone replacement therapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Menopause ‍likelysuspectedpossible

DDx: menopause, perimenopause, hormonal fluctuations, medication side effects (e.g., tamoxifen, raloxifene, aromatase inhibitors), hyperthyroidism, anxiety, panic disorder, carcinoid syndrome, pheochromocytoma, idiopathic hyperhidrosis, neurologic conditions, infection (e.g., tuberculosis, HIV), malignancies, lymphoma, GERD, obesity, diet (e.g., spicy foods, caffeine, alcohol), environmental factors (e.g., hot weather, warm rooms), substance withdrawal (e.g., alcohol, opioids), autonomic dysregulation





PLAN:

Investigations:

- Blood work: ‍CBC, ‍FSH, ‍LH, ‍estradiol, ‍TSH, ‍glucose, ‍LFTs, ‍creatinine, ‍β-hCG

- Urine: ‍urine catecholamines, ‍urine 5-HIAA

Treatments:

- Benefits of hormone replacement therapy discussed: control of symptoms, decrease in osteoporosis, endometrial cancer, colon cancer, myocardial infarction, and overall mortality

- Risk of hormone replacement therapy discussed: breast cancer, stroke, venous thromboembolism, gallbladder disease

- ‍Estrogens[Conjugated estrogensConjugated estrogens 0.3 mg po dailyConjugated estrogens 0.625 mg po dailyConjugated estrogens 1.25 mg po dailyEstradiolEstradiol 1 mg po dailyEstradiol 2 mg po daily]

- ‍Progesterone unnecessary if no uterus

- ‍Non-hormonal treatments

- ‍Over-the-counter remedies

- Reassess medications that may contribute to hot flashes (SSRIs, SNRIs, TCAs, opioids, tamoxifen, raloxifene, aromatase inhibitors, GnRH agonists, GnRH antagonists, antiandrogens, corticosteroids, isoniazid, hydralazine, niacin, metronidazole)

- Avoid hot environments

- Avoid caffeine

- Avoid alcohol

- Avoid spicy foods

- Regular exercise

Further care:

- Referral to endocrinologist

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if hot flashes worsen, if new symptoms develop such as fever, chills, or weight loss