Diagnosis of Hot flashes
Hot flashes Diagnosis: Book Excerpts
Diagnostic Tests for Hot flashes: Online Medical Books
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FACIAL FLUSHING:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is the flushing constant or intermittent? Intermittent flushing suggests menopause, carcinoid syndrome, systemic mastocytosis, pheochromocytoma, and Zollinger-Ellison syndrome. Constant flushing might suggest alcoholism, polycythemia, or the malar flush of mitral stenosis.
- Is there associated obesity? Associated obesity would certainly bring to mind Cushing's syndrome, but it may also be associated with alcoholism.
- Is there associated rash on the face or elsewhere? A rash would most likely bring to mind rosacea if it is on the face, but if it is elsewhere, one might consider systemic mastocytosis or dermatomyositis.
- Are there associated systemic symptoms and signs? Diarrhea would suggest carcinoid or Zollinger-Ellison syndrome. A headache along with the flushing would suggest a systemic mastocytosis. Fainting might suggest pheochromocytoma or epilepsy.
DIAGNOSTIC WORKUP
Urinalysis for 5-HIAA should be done if carcinoid syndrome is suspected. Urine samples may be taken for drug and alcohol screen in all cases in which there is any doubt about drug or alcohol history. Tests for serum FSH and estradiol should be done in patients suspected of having menopause. A 24-hr urine collection for catecholamine should be done for patients suspected of having pheochromocytoma. Serum gastrin tests should be done for patients suspected of having Zollinger-Ellison syndrome. In patients with systemic mastitis or dermatomyositis, a skin biopsy or muscle biopsy can be done. In patients with suspected Cushing's disease, a serum cortisol and cortisol suppression test can be done.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
FLUSHED FACE (PLETHORA):
Approached to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical picture will often point to the diagnosis. For example, a flushed face with obesity would suggest Cushing syndrome. A flushed face with a heart murmur would suggest mitral stenosis or a right to left shunt with polycythemia. A flushed face with wheezing would suggest pulmonary emphysema. A flushed face and chronic diarrhea would prompt one to consider a carcinoid syndrome.
The initial workup should include a CBC, chemistry panel, arterial blood gas analysis, urinalysis, chest x-ray, and ECG. If carcinoid syndrome is suspected, a urine for 5-HIAA is ordered. If alcoholism is suspected, a blood alcohol level can be done. If menopause is suspected, serum FSH and LH levels should be ordered. If Cushing syndrome is suspected, a serum cortisol level and a cortisol suppression test could be done. If systemic mastocytosis is suspected, a skin or muscle biopsy may be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Menopause:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Patient history and typical clinical features suggest menopause. A Papanicolaou (Pap) test may show the influence of estrogen deficiency on vaginal mucosa. Radioimmunoassay (RIA) may be performed, but because of the expense involved, it isn’t necessary to confirm a diagnosis of menopause. If done, RIA shows the following blood hormone levels:
❑ estrogen: 0 to 14 ng/dl
❑ plasma estradiol: 15 to 40 pg/ml
❑ estrone: 25 to 50 pg/ml.
RIA also shows the following urine values:
❑ estrogen: 6 to 28 µg/24 hours
❑ pregnanediol (urinary secretion of progesterone): 0.3 to 0.9 mg/24 hours.
Follicle-stimulating hormone production may increase as much as 15 times its normal level; luteinizing hormone production, as much as 5 times.
Pelvic examination, endometrial biopsy, and dilatation and curettage may rule out organic disease in patients with abnormal menstrual bleeding.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Flushing:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Perimenopause
❑ Alcohol/toxic
❑ Rosacea
❑ Palmar erythema
❑ Niacin
❑ Monosodium glutamate
❑ Carcinoid
❑ Pheochromocytoma
❑ Medullary thyroid carcinoma
❑ Scombroid
❑ Mastocytosis
Diagnostic Approach
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
FLUSHED FACE (PLETHORA):
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical picture will often point to the diagnosis. For example, a
flushed face with obesity would suggest Cushing syndrome. A flushed face
with a heart murmur would suggest mitral stenosis or a right to left shunt
with polycythemia. A flushed face with wheezing would suggest pulmonary
emphysema. A flushed face and chronic diarrhea would prompt one to consider
a carcinoid syndrome.
The initial workup should include a CBC, chemistry panel, arterial blood gas
analysis, urinalysis, chest x-ray, and ECG. If carcinoid syndrome is
suspected, a urine test for
5-HIAA is ordered. If alcoholism is suspected, a blood alcohol level can be
done. If menopause is suspected, serum follicle-stimulating hormone (FSH)
and luteinizing hormone (LH) levels should be ordered. If Cushing syndrome
is suspected, a serum cortisol level and a cortisol suppression test could
be done. If systemic mastocytosis is suspected, a skin or muscle biopsy may
be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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