Research Article| Volume 27, ISSUE 3, P203-214, July 1997

Download started.


Differential diagnosis of hot flashes

      This paper is only available as a PDF. To read, Please Download here.


      Objective: The purpose of this study is to present the physiology and differential diagnosis of hot flashes, other than associated with menopause, in order to facilitate the proper evaluation of symptomatic patients with hot flashes. Study Design: Literature search using Med-Line computer access. Results: Interest in flushing reaction began in historic times. With the rapidly expanding population of women over the age of 45 and prevalence of hot flashes as menopausal symptoms, physicians need to be aware of other medical conditions which may mimic hot flashes. These include flushing due to systemic diseases, carcinoid syndrome, systemic mast cell disease, pheochromocytoma, medullary carcinoma of the thyroid, pancreatic islet-cell tumors, renal cell carcinoma, neurological flushing, emotional flushing, spinal cord injury, flushing reaction related to alcohol and drugs, flushing associated with food additives, and eating. Conclusion: There is a wide variety of disease processes that can cause hot flashes. Knowledge of the nature of these disease processes is necessary for quick recognition of patients with hot flashes who do not respond to estrogen replacement treatment, and to facilitate the proper evaluation of atypical patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kronenberg F
        Hot flashes: epidemiology and physiology.
        Ann NY Acad Sci. 1990; 592: 52-86
        • Kronenberg F
        • Downey J
        Thermoregulatory physiology of menopausal hot flashes.
        Canadian J Physiol Pharmacol. 1987; 65: 1312-1322
        • Brick JF
        • Crosby TW
        Hot flash epilepsy.
        Southern Med J. 1988; 81: 1-98
        • Penfield W
        • Jasper H
        Epilepsy and the Functional Anatomy of Human Brain. Little Brown and Co, Boston1954: 77-88
        • Penfield W
        • Jasper H
        Epilepsy and the Functional Anatomy of Human Brain. Little Brown and Co, Boston1954: 105-106
        • Penfield W
        • Jasper H
        3rd edition. Epilepsy and the Functional Anatomy of Human Brain. Little Brown and Co, Boston1954: 396-401
        • Reed WB
        • Pidgeon J
        • Becker SW
        Patients with spinal cord injury clinical cutaneous studies.
        Arch Dermatol. 1960; 83: 379-385
        • Stanworth PA
        The significance of hyperhidrosis in patients with post-traumatic syringomyelia.
        Paraplegia. 1982; 20: 282-287
        • Burgess TH
        3rd edition. The Physiology or Mechanism of Blushing. John Churchill, London1839: 202
        • Campbell H
        3rd edition. Flushing and Morbid Blushing. H.K. Lewis, London1890: 1-270
        • Darwin C
        3rd edition. The Expression of the Emotions in Man and Animals. University Press, Chicago1965: 372
        • Freedman RR
        • Norton D
        • Woodward S
        • Cornélissen G
        Core body temperature and circadian rhythm of hot flashes in menopausal women.
        J Clin Endocrinol Metab. 1995; 80: 2354-2358
        • Freedman RR
        • Woodward S
        • Sabharwal SC
        α2-Adrenergic mechanism in menopausal hot flushes.
        Obstet Gynecol. 1990; 76: 573-578
        • Wilkin JK
        Why is flushing limited to a mostly facial cutaneous distribution.
        J Am Acad Dermatol. 1988; 19: 309-313
        • Wilkin JK
        Flushing reactions.
        in: 3rd edition. Recent Advances in Dermatology. Churchill Livingstone, London1983: 157-187 (No. 6)
        • Oates JA
        • Sjoerdsma A
        A unique syndrome associated with secretion of 5HT by metastatic gastric carcinoids.
        Am J Med. 1962; 32: 333-342
        • Vetraux J
        • Salmon RJ
        • Lanquille O
        • et al.
        Carcinoid tumor of common bile duct.
        Am J Gastroenterol. 1981; 76: 360-362
      1. Engleman K. Personal Observations.

        • Primack A
        • Wilson J
        • O'Connor GT
        • Engelman K
        • Hull E
        • Canellos GP
        Hepatocellular carcinoma with the carcinoid syndrome.
        Cancer. 1971; 27: 1182-1189
        • Dockerty MB
        Carcinoid tumors.
        Calif Med. 1963; 99: 1182-1189
        • Hajdu SI
        • Winnawer SJ
        • Laird Myers WBP
        Carcinoid tumors: a study of 204 cases.
        Am J Clin Pathol. 1974; 61: 521-528
        • Martensson H
        • Nobin A
        • Sundler F
        Carcinoid tumors in the gastrointestinal tract: an analysis of 156 cases.
        Acta Chir Scand. 1960; 48: 81-88
        • Torvik A
        Carcinoid syndrome in a primary tumor of the ovary.
        Acta Pathol. 1960; 48: 81-88
        • Melmon KL
        • Sjoerdsma A
        • Mason DT
        Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors.
        Am J Med. 1965; 39: 568-581
        • Farrior III, JB
        • Hyams VJ
        • Benke RH
        • Farrior JB
        Carcinoid apudoma arising in a glomus jugular tumor.
        Laryngoscope. 1980; 90: 110-119
        • Kaplan EL
        • Sizemore GW
        • Peskin GW
        • Jaffe BM
        Humoral similarity of carcinoid tumors and medullary carcinoma of the thyroid.
        Surgery. 1973; 74: 21-29
        • Matsuyama M
        • Inoue T
        • Ariyoshi Y
        • Doi M
        • Suchi T
        • Sto T
        • Tashiro K
        Argyrophil cell carcinoma of the uterine cervix with ectopic production of ACTH B-MSH, serotonin, histamine, and amylase.
        Cancer. 1979; 44: 1813-1823
        • Engleman K
        Malignant carcinoid syndrome.
        in: 3rd edition. Textbook of Endocrinology. vol. 3. Saunders, Philadelphia1995: 2649-2657
        • Adamson AR
        • Peart WS
        • Graham-Smith DG
        • Starr M
        Pharmacological blockage of carcinoid flushing provoked by catecholamines and alcohol.
        Lancet. 1969; 2: 595
        • Frolich JC
        • Bloomgarden ZT
        • Oates JA
        • McGuigan JE
        • Rabinowitz D
        The carcinoid flush provocation by pentagastrin and inhibition by somatostatin.
        N Engl J Med. 1978; 299: 1055-1057
        • Braunwald E
        • Isselbacher KJ
        Wilson JD Braunwald E Isselbacher KJ Petersdorf RG Martin JB Fauci AS Root RK Harrison's Principles of Internal Medicine. 12th ed. McGraw-Hill, New York1991
        • Oates JA
        • Butler TC
        Pharmacologic and endocrine aspects of carcinoid syndrome.
        Adv Pharmacol. 1967; 5: 109-128
        • Roberts II, LJ
        • Sweetman BJ
        • Lewis RA
        • Folarin VF
        • Austen KF
        • Oates JA
        Increased production of PGD2 in patients with mastocytosis.
        N Eng J Med. 1980; 303: 1400-1404
        • Demis DJ
        The mastocytosis syndrome: clinical and biological studies.
        Ann Intern Med. 1963; 59: 194-206
        • Webb T.A.
        • Li Chin
        • Yam Lung T.
        Systemic mast cell disease.
        Cancer. 1982; 49: 927-938
        • Parker CW
        • Cryer PG
        • Kissane J.M.
        Systemic mastocytosis.
        Am J Med. 1976; 61: 671-680
      2. Wyngaarden JB Smith Jr, LH Cecil Textbook of Medicine. 18th ed. Saunders, Philadelphia1988
        • Bravo EL
        • Gifford Jr, RW
        Pheochromocytoma: diagnosis, localization, and management.
        N Eng J Med. 1984; 311: 1298-1303
        • Engelman K
        Clin Endocrinol Metab. 1977; 6: 769-797
        • Hamilton BP
        • Landsberg L
        • Levine RJ
        Measurement of urinary epinephrine in screening for pheochromocytoma in men.
        Am J Med. 1978; 65: 1027-1032
        • Duncan MW
        • Compton P
        • Lazarus L
        • Smythe GA
        Measurement of norepinephrine and 3,4-dihydroxyphenylglycol in urine and plasma for the diagnosis of pheochromocytoma.
        N Engl J Med. 1988; 319: 136-142
        • Ross EJ
        • Prichard BN
        • Kaufman L
        • Robertson AI
        • Harries BJ
        Preoperative and operative management of patients with pheochromocytoma.
        Br Med J. 1971; 1: 191-198
        • Laursen K
        • Damgaard-Pederson K
        CT for pheochromocytoma diagnosis.
        Am J Roentgenol. 1980; 134: 277-280
        • Sizemore GW
        • Carney JA
        • Heath III, H
        Epidemiology of medullary carcinoma of the thyroid gland.
        Surg Clin North Am. 1977; 57: 633-645
        • Krejs GJ
        Vipoma syndrome.
        Am J Med. 1981; 82: 37-48
        • Cronin RE
        • Kaehny WD
        • Miller PD
        • Stables DP
        • Gabow PA
        • Ostroy PR
        • Schrier R
        Renal cell carcinoma: unusual systemic manifestations.
        Medicine. 1976; 55: 291-311
        • Cronan J
        • Zeman RK
        Renal mass imaging. The internist's role.
        Am J Med. 1986; 81: 1026-1032
        • Brodsky G
        • Garnick MG
        Renal tumors in the adult patient.
        in: Tisher CC Brenner BM Renal Pathology. Lippincott, Philadelphia1989: 1467
        • American Psychiatric Association
        3rd ed., rev. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Press, Washington1987: 567
        • Wilkin JK
        Effect of nadolol on flushing reactions in rosacea.
        J Am Acad Dermatol. 1989; 20: 202-205
        • Sato K
        • Kang WH
        • Saga K
        • Saga K
        • Sato KI
        Biology of sweat glands and their disorders. II. Disorders of sweat gland function.
        J Am Acad Dermatol. 1989; 20: 713-726
        • Rowland LP
        Nervous System Diseases.
        in: Textbook of Neurology. 8th ed. Lea and Febiger, Philadelphia1989: 964