EpistemisIntolerance to environmental thermal variations
Specialty: General.
Why it occurs
- Pure or secondary autonomic dysautonomia (amyloid neuropathy, diabetic neuropathy, which prevent adequate cutaneous vasoconstriction in the face of cold and vasodilation/sweating in the face of heat)
- Thyroid function disorders with an oscillating course (Hashimoto's thyroiditis in the phase of transient thyrotoxicosis followed by primary hypothyroidism)
- Decompensated chronic adrenal insufficiency (alteration of mineralocorticoid control and systemic capillary perfusion necessary for thermoregulation)
- Severe physiological aging of the central thermoregulatory systems and peripheral cutaneous receptors
- Consumption of psychotropic drugs that interfere with hypothalamic thermoregulation (antipsychotics, tricyclic antidepressants, lithium).
Initial workup
Autonomic function profile (quantitative sweat tests, tilt table test), complete thyroid profile with anti-TPO antibodies, morning cortisol with ACTH stimulation if indicated, complete blood count, and erythrocyte sedimentation rate.
red flags
Development of febrile spikes or severe hypothermia refractory to environmental control, associated with severe mental confusion, thermal hallucinations, severe hypotension, positional syncope or oppressive chest pain.
Standard management
- Avoid drugs that exacerbate thermoregulatory autonomic instability
- Clonidine — 0.075 mg orally every 12 or 24 hours to stabilize central sympathetic nervous system reactivity
- Supplementation with omega-3 essential fatty acids and vitamin E to support general skin microcirculation.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3