Hello sillykitty,
Thanks for requesting me to ask this question. Although I am an
internal medicine physician, please see your primary care physician
for specific questions regarding any individual cases – please do not
use Google Answers as a substitute for medical advice. I will be
happy to answer factual medical questions.
I will now answer your question:
“What are diseases that can cause flushing, weight loss, and insomnia,
and how can they be evaluated?”
To start and to receive a complete cause list, I used Dxplain which is
a computerized differential diagnosis program.
Using the symptoms:
“chronic, flushing, weight loss, insomnia”
Common causes:
Menopause syndrome
Hyperthyroidism
Lung, carcinoma, bronchogenic
Stomach, carcinoma
Tuberculosis, pulmonary
Pancreatitis, chronic
Endogenous Depression
Rare causes:
Graves disease
Carcinoid syndrome
Pheochromocytoma
Mastocytosis, systemic
Mycosis fungoides
I will start my discussion with the most likely causes, which are
perimenopause/menopause syndrome and hyperthyroidism. I will also
briefly discuss some of the rarer causes (i.e. lung and stomach
cancer).
1) Perimenopause and menopause
Perimenopause is defined as the two to eight years preceding menopause
and the one year after the last menstrual period. It is characterized
by a normal ovulatory cycle interspersed with anovulatory
(estrogen-only) cycles of varying length. As a result, menses become
irregular, and heavy breakthrough bleeding, termed dysfunctional
uterine bleeding, can occur during longer periods of anovulation.
Thus, vaginal bleeding becomes unpredictable in both timing and
amount. In addition, some women complain of hot flashes and vaginal
dryness.
Menopause is defined as the cessation of menstrual periods in women
that occurs at about age 50 years. It is a well-defined event,
although ovarian function begins to decrease one to two years earlier.
A clinical diagnosis of menopause is made by the presence of
amenorrhea for six to twelve months, together with the occurrence of
symptoms of menopause such as hot flashes. If the diagnosis is in
doubt, the pathognomonic finding is a high serum concentration of
follicle-stimulating hormone (FSH). The absolute serum FSH
concentration that is diagnostic of menopause varies depending upon
the assay used; however, it will always be above the upper limit of
normal for reproductive-age women, excluding the serum FSH values
reached during the midcycle gonadotropin surge. A serum FSH value of
10 to 25 mIU/mL on day 3 of the menstrual cycle suggests that
spontaneous or pharmacologically assisted pregnancy is unlikely.
The age of menopause is reduced by about two years in women who smoke.
There is also a tendency for women who have never had children and for
those with more regular cycles to have an earlier age of menopause.
Other factors that may be important include:
· a family history of early menopause
· a history of type 1 diabetes mellitus
· shorter cycle length during adolescence (which is also a predictor
of higher basal FSH).
Regarding the symptoms specifically. From UptoDate:
“Hot flashes — The most common acute change during menopause is the
hot flash, which occurs in 75 percent of women. This symptom is
centrally mediated, as evidenced by the temporal relationship of
pulses of LH secretion to hot flashes. They are self-limited, with 50
to 75 percent of women having cessation of hot flashes within five
years.
Hot flashes typically begin as the sudden sensation of heat centered
on the face and upper chest that rapidly becomes generalized. The
sensation of heat lasts from two to four minutes, is often associated
with profuse perspiration and occasionally palpitations, and is often
followed by chills and shivering. Hot flashes usually occur several
times per day, although the range may be from only one or two each day
to as many as one per hour during the day and night.
Hot flashes represent thermoregulatory dysfunction; there is
inappropriate peripheral vasodilatation with increased digital and
cutaneous blood flow and perspiration. These changes result in rapid
heat loss and a decrease in core body temperature below normal.
Shivering then occurs as a normal mechanism to restore the core
temperature (2).
Sleep disturbance and depression — A distressing feature of hot
flashes is that they are invariably associated with arousal from sleep
(3). Because they can occur as often as once per hour, the result is
marked sleep disruption in some women. A continuing sleep disturbance
may lead to fatigue, irritability, depression, difficulty
concentrating, and other emotional and psychological symptoms that
have been attributed to the menopause.
Studies that have investigated the relationship between depression and
menopause have been conflicting. Most longitudinal population-based
studies have not found an association (4). On the other hand, one
cohort study reported that 51 percent of 477 menopausal women
complained of symptoms of depression at least once during the
three-year follow-up period (5). However, stresses associated with
family life were thought to be more responsible for the symptoms than
hormonal changes. Other studies have found increased rates of
depression among menopausal women who had a history of depression
(6).”(1)
2) Hyperthyroidism
From Merck Medicus:
“Hyperthyroidism is the condition that results from the effect of
excessive amounts of thyroid hormones on body tissues. It is a common
condition with diverse presentations. The prevalence of
hyperthyroidism is ~0.5. In a recent survey at a health fair,
hyperthyroidism was found in 1.0% of the 24,337 subjects, but 90% of
these had only mild (subclinical) hyperthyroidism. Hyperthyroidism is
about three- to five-fold more prevalent in women than in men.
Symptoms can include fatigue, muscle weakness, nervousness, emotional
lability, inner tension, excessive sweating, intolerance to heat,
palpitations, and, especially in young patients, weight loss despite
increased appetite. Typical presenting symptoms are largely related
to increased sympathetic tone, such as nervousness, irritability,
hyperactivity, excessive sweating, and palpitations. Heat intolerance
and weight loss, despite increased appetite, are related to increased
energy production and utilization.”
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01EN11§ion=report&ss=1
From UptoDate:
“Hyperactivity, emotional lability, anxiety, inability to concentrate
and insomnia are other common symptoms. The symptoms of any
preexisting psychiatric disorder are likely to be exacerbated.” (7)
The diagnosis is initially made by blood tests to measure the amount
of thyroid hormone and thyroid-stimulating hormone (TSH). Typically,
in the patient with hyperthyroidism, the thyroid hormone level is high
and the TSH level is low. If the test is consistenet with
hyperthyroidism, a thyroid scan might be done to help determine which
type of hyperthyroidism is present (Graves' disease, toxic nodular
goiter, or thyroiditis).
3) Depression
The DSM-IV criteria for major depression require that at least five of
the following nine symptoms are present during the same period.
· Depressed mood most of the day, particularly in the morning
· Markedly diminished interest or pleasure in almost all activities
nearly every day (anhedonia); these can be indicated by the subjective
account or observations by significant others
· Significant weight loss or gain
· Insomnia or hypersomnia
· Psychomotor agitation or retardation
· Fatigue or loss of energy
· Feelings of worthlessness or guilt
· Impaired concentration, indecisiveness
· Recurring thoughts of death or suicide
One of the symptoms must be either depressed mood or loss of interest.
Symptoms should be present daily or for most of the day, or nearly
daily for at least two weeks. The symptoms must cause clinically
significant distress or impairment in functioning, are not due to the
direct effects of a substance (eg, drug abuse or medications) or a
medical condition (eg, hypothyroidism), and do not occur within two
months of the loss of a loved one.
From UptoDate:
“There is currently no biologic marker for depression, although the
following may be seen in depressed individuals:
· Early REM latency (dreaming as soon as falling asleep)
· Early morning awakening
· Poor appetite
· Weight loss
· Pseudodementia (diminished cognitive performance that resolves with
successful treatment of depressive symptoms)” (9)
4) Lung and Stomach Cancer
The symptoms that are described may be associated with bronchogenic
(lung) and stomach cancer – as was suggested above in the list of
causes. The presentation of cancer also is associated with other
symptoms. I will present symptoms of lung and stomach cancer – if
this is suspected, follow-up with a primary care physician is strongly
recommended for appropriate evaluation and management.
A detailed description of the symptoms of lung cancer can be found
here:
Merck Medicus – Neoplasms of the Lung
http://merck.micromedex.com/bpm/bpm.asp?page=CPM02PU282§ion=report&ss=4
Regarding stomach cancer, the symptoms are from UptoDate:
“Weight loss and persistent abdominal pain are the most common
symptoms at initial diagnosis:
· Weight loss usually results from insufficient caloric intake rather
than increased catabolism, and may be attributable to anorexia,
nausea, abdominal pain, early satiety, and/or dysphagia.
· The abdominal pain tends to be vague and mild early in the disease,
but more severe and constant as the disease progresses.
· Dysphagia (difficulty swallowing) is a common presenting symptom in
patients with cancers arising in the gastric cardia or at the
esophagogastric junction.
Patients may also present with nausea or early satiety from gastric
outlet obstruction or gastric stasis related to tumor infiltration of
the stomach wall. Occult gastrointestinal bleeding with or without
iron deficiency anemia is common, while overt bleeding is seen in only
20 percent of cases. The presence of a palpable abdominal mass is the
most common physical finding and generally indicates long-standing,
advanced disease.” (8)
I will not detail the evaluation and diagnosis of suspected lung or
stomach cancer here as it is involved and requires a true
doctor-patient relationship. If this is suspected, please consult a
physician.
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Thanks,
Kevin, M.D.
Internet search strategy:
No internet search engine was used in this research. All sources were
from objective physician-written and peer reviewed sources.
Bibliography:
1) Casper. Diagnosis and clinical manifestations of menopause.
UptoDate, 2002.
2) Casper, RF, Yen, SS. Neuroendocrinology of menopausal flushes: An
hypothesis of flush mechanism. Clin Endocrinol (Oxf) 1985; 22:293.
3) Erlik, Y, Tataryn, IV, Meldrum, DR, et al. Association of waking
episodes with menopausal hot flushes. JAMA 1981; 24:1741.
4) Pearlstein, T, Rosen, K, Stone, AB. Mood disorders and menopause.
Endocrinol Metab Clin North Am 1997; 26:279.
5) Kaufert, PA, Gilbert, P, Tate, R. The Manitoba Project: A
re-examination of the link between menopause and depression. Maturitas
1992; 14:143.
6) Avis, NE, Brambilla, D, McKinlay, SM, Vass, K. A longitudinal
analysis of the association between menopause and depression. Results
from the Massachusetts Women's Health Study. Ann Epidemiol 1994;
4:214.
7) Ross. Overview of the clinical manifestations of hyperthyroidism
in adults. UptoDate, 2002.
8) Schroy. Clinical features of gastric cancer. UptoDate, 2002.
9) Paulsen. Depression in adults: Pathophysiology, clinical
manifestations and diagosis. UptoDate, 2002.
Links:
Merck Medicus – Hyperthyroidism
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01EN11
Merck Medicus – Neoplasms of the Lung
http://merck.micromedex.com/bpm/bpm.asp?page=CPM02PU282§ion=report
Merck Medicus – Depression
http://merck.micromedex.com/bpm/bpm.asp?page=BPM01PS19§ion=report&ss=1&hilight=depression
Merck Medicus – Menipause and the postmenopause syndrome
http://merck.micromedex.com/bpm/bpm.asp?page=CPM02EN327§ion=report&ss=1&hilight=menopause |
