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Hot flashes and fatigue relieved by metformin
Vinay Maudar1, Stephen J Winters, Betty C Villafuerte
1Department of Medicine, Division of Endocrinology and Metabolism, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Objective:
To describe 3 patients with long-standing hot flashes, excessive sweating, and fatigue whose symptoms were ameliorated with metformin.
Methods:
In this case series, we report the findings of laboratory evaluations, including assessments for thyroid, gonadal, adrenal, and pancreatic disorders, in 3 patients referred for endocrine evaluation. A 75-g oral glucose tolerance test with measurement of fasting and postprandial glucose and insulin concentrations was conducted. A trial of metformin, 500 mg twice daily, was initiated in all patients.
Results:
Evaluation of factors that are associated with hot flashes and increased sweating did not establish the cause of the patients' symptoms. The 3 patients had normal glucose tolerance test results and hyperinsulinemia. Metformin therapy markedly relieved the symptoms in all patients.
Conclusions:
Hyperinsulinemia without hypoglycemia may produce a sympathoexcitatory response that manifests as hot flashes and increased sweating. Metformin may have sympathoinhibitory actions that alleviate these symptoms.
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