Systemic vasomotor instability

Specialty: General.

• vasomotor lability
• general vasomotor dysfunction
• poor temperature regulation and peripheral perfusion

Why it occurs

• Menopause and climacteric transition (decrease in estrogen that destabilizes the activity of KNDy neurons in the hypothalamic infundibulum, deregulating the thermoregulatory center)
• Dysautonomia or dysfunction of the sympathetic autonomic nervous system (pure autonomic insufficiency, diabetic cardiovascular neuropathy or multiple system atrophy)
• Chronic use or fluctuating regimen of calcium channel blockers or beta-blockers (which alter the physiological capacity for vasoconstriction and peripheral vasodilation)
• Systemic Raynaud's syndrome with atypical presentation (episodic vasospasm that affects the extremities, ears and tip of the nose due to minimal changes in temperature)
• Hypermetabolic endocrine disorders (silent pheochromocytoma or initial hyperthyroidism that generate peaks of heat and cold with sweating).

Initial workup

24-hour ambulatory blood pressure monitoring (ABPM), transthoracic echocardiogram, cardiac autonomic function tests (Valsalva maneuver, controlled deep breathing), urinary metanephrine dosage, and thyroid profile.

Standard management

• Clonidine — 0.075 mg orally every 12 hours, useful for stabilizing vasomotor tone by regulating central adrenergic discharge
• Propranolol — 10 to 20 mg orally twice daily to control palpitations and sympathetic flushing
• Cimicifuga racemosa extract (40 mg per day orally as an alternative therapy in vasomotor instability associated with menopause).