Ask a doctor on the topic of General medicine

Sudden hot flashes and sweating when in a bent position?

May 6, 2014 | 150,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

I am aware that without thorough examinations, a remote diagnosis based solely on the patient's descriptions is very difficult. Nevertheless, I would appreciate any possible answers or hints that I can then pursue in real life. I am a male, almost 40 years old, with 20 kilos of excess weight (although I also lose weight quite quickly when I am determined), and I am a smoker. I am slowly reaching an age where the first gray hairs are showing up in places that I didn't even know I had.

I have been experiencing a problem for the past few months: I get hot flashes of the most extreme kind more or less out of nowhere. It usually starts at my feet and shins. My whole body seems to be glowing, and sweat drips down my armpits. By the way, I drink about 2-3 liters of water a day. Medically, I have been examined in the area of the thyroid, heart, lungs, blood tests, and more. There were no particular abnormalities found.

However, I can link the occurrence of these hot flashes to certain circumstances or events. They seem to be very weather-dependent. For example, yesterday when it was quite warm in our region and I was out a lot with our dogs: No sense of heat, no sweating (except normal sweating from regular activity). Today, it's rather humid here, with a slightly overcast sky.

I have experienced these flashes indoors 95% of the time, rarely outdoors, now once independent of the weather. I cannot rule out psychological factors, but I am not consciously aware of any fears (e.g. of enclosed spaces). These flashes also do not occur in the car. Another factor seems to be what I am doing at the time because 90-95% of the time these flashes occur when I am vacuuming or scrubbing the floor. It's as if this bent posture triggers these attacks.

When I go outside with one of my dogs during such an attack (regardless of the weather, even if it's warm), these attacks disappear quite quickly - despite the effort of walking. This is something I can't quite understand. I know that there are male menopause symptoms - but so far no doctor has looked into it further, hormone tests came back normal. But even if it were hormones: why would these surges only occur during the aforementioned activities? The only finding I can mention is a herniated disc, which hardly causes any pain.

I am at a loss, I hope you are not entirely?

Dr. med. Frauke Gehring

Hello,

I have thought about various possibilities regarding your problem. I believe we can rule out a psychological cause, as panic attacks would also occur in the car, and since it is only about sweating outbreaks, not accompanied by anxiety or restlessness.

I can think of three possible causes.

One is an inflammatory lung disease (COPD, Boeck's disease, tuberculosis), which has not yet shown any other symptoms except for some coughing. I would strongly recommend getting a chest X-ray.

The second is a dysregulation of the autonomic nervous system. When bending over, you put pressure on the stomach, which irritates the autonomic nervous system. If you have stomach problems, it would be worth looking into that as well, as there are people with severe gastritis who have few symptoms. Such inflammation can also cause more "heat," occurring in attacks when the stomach is pressed.

The third option is one that neither you nor I would like: there are cases of sweating attacks as a concomitant of malign tumors (paraneoplastic syndrome). You have already been examined urologically, a chest X-ray is necessary anyway, and hopefully, the blood tests have ruled out lymphomas and leukemias. I would also recommend an ultrasound of the abdominal organs and a test for hidden blood in the stool. Depending on the results and any other symptoms you may have but not considered important and therefore not mentioned, targeted further investigation may be necessary.

I hope that your autonomic nervous system simply does not tolerate pressure on the stomach, and that some weight loss may resolve the issue. However, I urge you to undergo the mentioned examinations and wish you all the best.

Sincerely, Dr. Höllering, specialist in internal and general medicine.