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The endocrine evaluation of three children with vasomotor flushes following hypothalamic surgery
Insights
Hot flushes, previously seen in menopause, are now reported in children after hypothalamic-pituitary surgery. These vasomotor symptoms can occur regardless of estrogen levels or gonadotropin status.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Surgical Neurology
Background:
- Vasomotor instability, commonly known as hot flushes, is a hallmark symptom of menopause in women.
- These symptoms have not been previously documented in pediatric populations.
Observation:
- Three children at various pubertal stages experienced vasomotor instability post-surgery involving the hypothalamic-pituitary region.
- A 16-year-old female with low estradiol developed symptoms post-operatively.
- A 12-year-old male with normal hormone levels and a prepubertal male also experienced hot flushes after surgery.
Findings:
- The development of hot flushes in these pediatric cases does not necessitate estrogen deficiency or gonadotropin excess.
- Post-operative vasomotor instability may stem from pressure effects or direct manipulation of the hypothalamic-pituitary area.
Implications:
- This study expands the understanding of hot flush etiology beyond hormonal deficiencies.
- Suggests a potential link between hypothalamic-pituitary region surgery and the onset of vasomotor instability in children.
- Highlights the need for further research into the neurobiological mechanisms underlying post-operative hot flushes in pediatric patients.
Abstract:
Although vasomotor instability or hot flushes are a well-known occurrence in women with natural or artificially-induced menopause, they have not previously been described in children. We report three children in different stages of puberty who developed vasomotor instability following surgery involving the hypothalamic-pituitary region. One, a 16 7/12 year old female with Tanner III breast development, had low oestradiol levels both pre- and post-operatively, but developed vasomotor symptoms only in the post-operative period. The second, a 12 4/12 year old boy, was sexually mature and had normal male levels of testosterone and total oestrogen when he developed hot flushes post-operatively. The third case, a boy, was prepubertal at the time of craniopharyngioma resection. Our results support the conclusion that neither oestrogen deficiency nor gonadotrophin excess are absolute requirements for the development of hot flushes. It is possible that either pressure-related factors or actual manipulation of the hypothalamic-pituitary region result in biochemical changes which result in the development of post-operative vasomotor instability in these children.