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Essentials of Menopause Management pp 239–252Cite as

Bothersome Vasomotor Symptoms: Management in Women with Type 2 Diabetes Mellitus (Case 1) and Differential Diagnostic Considerations (Case 2)

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Abstract

A 58-year-old patient presents to our menopause clinic for treatment of bothersome hot flashes. Her last menstrual period occurred at age 52. The patient learned at age 56 that she had type 2 diabetes mellitus. A random blood glucose on a chemistry panel ordered for evaluation of fatigue was elevated, and the diagnosis was confirmed by an HgA1C ≥6.5 %. Glucose control has been normalized on metformin therapy. The patient is also hypertensive and well controlled with a combination of a calcium channel blocker (amlodipine) and an angiotensin-converting enzyme inhibitor (benazepril). She knows her medical concerns would be improved by weight loss but she seems stuck at 200 pounds (BMI 32 kg/m2). She isn’t refreshed after a night’s rest and wants relief from her hot flashes. She also notes that her husband has started to complain about her snoring. What are the options for treating her hot flashes? How best should you prioritize her medical concerns and balance her management choices?

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References

  1. American Diabetes Association. Statistics about diabetes. www.diabetes.org/diabetes-basic/statistics/?loc+db-slabnav. Accessed 6/9/2016.

  2. American Diabetes Association. Classification and diagnosis of diabetes. Sec. 2. In Standards of medical Care in Diabetes—2016. Diabetes Care. 2016;39(Suppl 1):S13–22.

    Google Scholar 

  3. Siu AL. on behalf of the U.S. Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163:861–8.

    Article  PubMed  Google Scholar 

  4. Dougherty P, Pastors JG. Women & diabetes. Menopause. What to expect, how to cope. Diabetes Self Manag. 2007;24:84–7.

    PubMed  Google Scholar 

  5. American Diabetes Association. Foundations of care and comprehensive medical evaluation. Sec. 3. In Standards of Medical Care in Diabetes 2016. Diabetes Care. 2016;39(Suppl.1):S23–35.

    Google Scholar 

  6. Qaseem A, Dallas P, Owens DK, Starkey M, Holty JE, Shelelle P, Clinical Guidelines Committee of the American College of Physicians. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:210–20.

    Article  PubMed  Google Scholar 

  7. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159:471–83.

    Google Scholar 

  8. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383:736–47.

    Article  PubMed  Google Scholar 

  9. Regensteiner JG, Golden S, Huebschmann AG, Barrett-Connor E, Chang AY, Chyun D, et al. Sex differences in the cardiovascular consequences of diabetes mellitus. A Scientific Statement from the American Heart Association. Circulation. 2015;132:2424–47.

    Article  PubMed  Google Scholar 

  10. Goff Jr DC, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73.

    Article  PubMed  Google Scholar 

  11. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:3975–4011.

    Article  CAS  PubMed  Google Scholar 

  12. Fox CS, Hill Golden S, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence. A Scientific Statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132:691–718.

    Article  CAS  PubMed  Google Scholar 

  13. American Diabetes Association. Cardiovascular disease and risk management. Sec. 8. In Standards of Medical Care in Diabetes 2016. Diabetes Care. 2016;39(Suppl 1):S60–71.

    Google Scholar 

  14. Gilbert MP, Pratley RE. The impact of diabetes and diabetes medications on bone health. Endocr Rev. 2015;36(2):194–213. doi:10.1210/er.2012-1042. Epub 2015 Mar 4.

    Article  CAS  PubMed  Google Scholar 

  15. Tsilidis KK, Kasimis JC, Lopez DS, Ntzani EE, Ioannidis JP. Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies. BMJ. 2015;350:g7607. doi:10.1136/bmj.g7607.

  16. U.S. Preventive Services Task Force. Published recommendations for primary care practice. Cancer Screening. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=cancer+screenin. Current as of May 2016; Accessed 2 May 2016.

  17. Wild RA, Wu C, Curb JD, et al. Coronary heart disease events in the Women’s Health Initiative hormone trials: effect modification by metabolic syndrome: a nested case-control study within the Women’s Health Initiative randomized clinical trials. Menopause. 2013;20:254–60.

    PubMed  PubMed Central  Google Scholar 

  18. Mohammed K, Abu Dabrh AM, Benkhadra K, et al. Oral vs transdermal estrogen therapy and vascular events: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100:4012–20.

    Article  CAS  PubMed  Google Scholar 

  19. Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol. 2009;5(10):553–8. doi:10.1038/nrendo.2009.166. Epub 2009 Aug 18.

  20. Mottalib A, Sakr M, Shehabeldin M, Hamdy O. Diabetes remission after nonsurgical intensive lifestyle intervention in obese patients with Type 2 diabetes. J Diabetes Res. 2015. Epub 2015 May 31.

    Google Scholar 

  21. Steven S, Hollingsworth KG, Al-Mrabeh A, Avery L, Aribisala B, Caslake M, Taylor R. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care. 2016;39:808–15.

    Article  CAS  PubMed  Google Scholar 

  22. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22:1155–74.

    Google Scholar 

  23. The North American Menopause Society. Menopause practice. A clinician’s guide. 5th ed. The North American Menopause Society. Chapter 3. 2014; p. 56. Mayfield Heights, Ohio.

    Google Scholar 

  24. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. American Thyroid Association; American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17:456–520.

    Article  PubMed  Google Scholar 

  25. DeLeo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016. after 2016 ;388:906-18. [Epub ahead of print].

    Google Scholar 

  26. Liu EH, Solorzano CC, Katznelson L, Vinik AI, Wong R, Randolph G. On behalf of the AACE Endocrine Surgery Scientific Committee—Neuroendocrine Carcinoid Subgroup. AACE/ACE Disease State Clinical Review: Diagnosis and Management of Midgut Carcinoids. Endocr Pract. 2015;21:34–545.

    Article  Google Scholar 

  27. Vinik AI, Chaya C. Clinical presentation and diagnosis of neuroendocrine tumors. Hematol Oncol Clin North. 2016;30:21–48.

    Article  Google Scholar 

  28. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young Jr WR. Endocrine Society. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915.

    Article  CAS  PubMed  Google Scholar 

  29. Kiernan CM, Solorzano CC. Pheochromocytoma and paraganglioma: diagnosis, genetics, and treatment. Surg Oncol Clin N Am. 2016;25:119–38.

    Article  PubMed  Google Scholar 

  30. Edelman ER, Stuenkel CA, Rutherford JD, Williams GH. Diabetic ketoacidosis associated with pheochromocytoma. Cleve Clin JH Med. 1992;59:423–7.

    Article  CAS  Google Scholar 

  31. Fishbein L, Merrill S, Fraker DL, Cohen DL, Nathanson KL. Inherited mutations in pheochromocytoma and paraganlioma: why all patients should be offered genetic testing. Ann Surg Oncol. 2013;20:1444.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fishbein L. Pheochromocytoma and paraganglioma: genetics, diagnosis and treatment. Hematol Oncol Clin North Am. 2016;30:135.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of California, San Diego, School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, La Jolla, CA, USA

    Cynthia A. Stuenkel MD

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  1. Cynthia A. Stuenkel MD
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Correspondence to Cynthia A. Stuenkel MD .

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Editors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility Yale School of Medicine, New Haven, Connecticut, USA

    Lubna Pal

  2. Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA

    Raja A. Sayegh

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Stuenkel, C.A. (2017). Bothersome Vasomotor Symptoms: Management in Women with Type 2 Diabetes Mellitus (Case 1) and Differential Diagnostic Considerations (Case 2). In: Pal, L., Sayegh, R. (eds) Essentials of Menopause Management. Springer, Cham. https://doi.org/10.1007/978-3-319-42451-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-42451-4_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42449-1

  • Online ISBN: 978-3-319-42451-4

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