The endocrine evaluation of three children with vasomotor flushes following hypothalamic surgery.

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.