Hot flashes are traditionally linked to menopause, especially to estrogen deficiency. And it is probably the most common cause of hot flashes. However hot flashes can be caused by multiple other reasons. Some of them are even more important and may be life threatening.Estrogen deficiency is probably the most common cause of hot flashes. If found it needs to be corrected with transdermal estrogen, which is the most important component of hormone replacement therapy.
Progesterone deficiency can contribute to hot flashes, therefore it needs to be corrected as well with hormone replacement therapy.
Cortisol deficiency may cause hot flashes. Therefore at least 24 urine collections for cortisol should be done. If cortisol deficiency is found, then it should be compensated for with hormone replacement therapy.
Hyperthyroidism can cause hot flashes, indistinguishable from menopausal hot flashes.
Chills with sweating because of infection or tumors sometimes can be interpreted as hot flashes.
Bottom line: I advise a full workup in a patient with hot flashes, because the differential diagnosis is very extensive.
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