Night sweats: it may be hemochromatosis

Abstract

The aim of this case report is to show that hemochromatosis can present, unusually, with night sweats. At presentation, hemochromatosis often tends to have non-specific symptoms, making it easy to misdiagnose, especially if it presents with rare symptoms. Misdiagnosis of hemochromatosis can lead to lethal outcomes, given it can cause multiple organ dysfunctions if left untreated and hence the need to identify it early on. The case we present is a 41-year-old woman with previously undiagnosed hemochromatosis complaining of night sweats. She thought she was menopausal. The diagnosis of hemochromatosis was made solely on investigations given that she did not have any other symptoms other than night sweats. Her serum iron concentrations were within the normal range due to menstruation. It is uncommon for women to present with symptoms of hemochromatosis during their reproductive life since their iron concentration is kept within normal range through monthly menstrual bleeding.

The Case for an Estrogen-iron Axis in Health and Disease

“…The exact mechanism underlying the association between menopause and hot flashes is not clear. However, it has been observed that while iron deficiency associates with cold intolerance [57], high ferritin levels correlate with hot flashes [51]. Consistent with this observation is the finding that cessation of menstruation leads to a gradual increase in ferritin levels in postmenopausal women [49].…”

“…2), which may partially explain the paradoxical outcomes of HRT in postmenopausal women. Iron overload in postmenopausal women has been shown to increase the risk of hot flashes [51], osteoporosis [52], metabolic syndrome [53], cardiac hypertrophy and cardiovascular complications [54,55] and brain aging and neurodegenerative disorders [56] among others. Both iron and E2 have been separately implicated in diseases, but whether an E2-iron axis is at play has never been considered.…”