Hot Flushes in a 76-Year-Old Man

Malcolm S. Harris, MD; Harvey J. Schwartz, MD
JAMA. 1986;255(24):3364. doi:10.1001/jama.1986.03370240034021.
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To the Editor.—  One of us (M.H.) recently submitted to the QUESTIONS AND ANSWERS section of The Journal an inquiry concerning the etiology and treatment of hot flushes in a 76-year-old man.1 These episodes occurred intermittently over a five-year period up to five times per day, although predominantly at night. They were associated with urinary urgency but were not associated with wheezing, palpitations, headache, diarrhea, or feelings of depersonalization. Repeated investigations for the common causes of hot flushes—carcinoid, pheochromocytoma, thyrotoxicosis, and medication-related symptoms—were unrevealing.We received two responses from two endocrinologists. Dr Bravo suggested reassuring the patient that his was a benign condition and nothing should be done unless symptoms worsened, in which case extensive endocrinologic studies should be attempted during episodes. Dr Schwartz recommended more intensive workup for carcinoid and autonomic epilepsy, including a liver scan and electroencephalogram and a trial of anticonvulsant medication.A psychiatric consultation by


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