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night sweats
Perspiration during sleep at night of sufficient magnitude as to necessitate a change in bed clothing &/or bedding (sheets).
Etiology:
1) malignancy
a) lymphoma
- non-Hodgkin's lymphoma
- Hodgkin's disease*
b) solid tumors
- germ cell tumors
- medullary carcinoma of the thyroid
- prostate cancer
- renal cell carcinoma
- others
2) infections
a) mycobacterial
- tuberculosis*
- atypical mycobacteria
b) bacterial
- abscess
- endocarditis
- osteomyelitis
c) viral
- HIV
3) medications
4) substance withrawal
- alcohol, cocaine, opiates
5) endocrine disorders
a) carcinoid syndrome*
b) diabetes insipidus
c) hyperthyroidism
d) hypoglycemia
e) pheochromocytoma
f) post orchiectomy
6) menopause
7) neurologic disorders
a) autonomic dysreflexia
b) autonomic neuropathy
c) post-traumatic syringomyelia
d) stroke
8) miscellaneous
a) chronic fatigue syndrome
b) gastoesophageal reflux
c) mastocytosis
d) panic disorder
e) rosacea
f) sleep apnea
g) temporal arteritis
h) idiopathic hyperhidrosis
9) children [3]
- eye diseases
- atopic dermatitis
- respiratory disorders
- hyperactivity
- anxiety
* disorder to consider 1st
Epidemiology:
- 2% of patients report night sweats in past month
Clinical manifestations:
- other sleep-related symptoms in children [3]
Laboratory:
- complete blood count
- serum TSH
- HIV1 serology
- 24 hour urine 5-HIAA
- 24 hour urine metanephrines, 24 hour urine catecholamines
- blood cultures (endocarditis)
- bone marrow biopsy
Special laboratory:
- PPD
Radiology: chest X-ray, CT of thorax & abdomen
Differential diagnosis:
1) idiopathic hyperhidrosis
2) flushing
3) post-menopausal hot flashes
Management:
1) exclude fever
2) when possible, discontinue medications
3) empiric therapy not recommended
Related
diaphoresis
perspiration (sweating)
General
hyperhidrosis
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 928
- UpToDate version 13.3
- So HK et al.
Night sweats in children: Prevalence and associated factors.
Arch Dis Child 2011 Mar 22
PMID: 21427123