Approach to the patient with night sweats
- Gerald W Smetana, MD
Gerald W Smetana, MD
- Professor of Medicine
- Harvard Medical School
Night sweats are a common symptom in ambulatory primary care practice. While the cause may be evident after straightforward history taking, often no cause is immediately apparent. In these cases, clinicians face the challenge of determining a thoughtful, cost effective, yet comprehensive evaluation.
The definition and epidemiology of night sweats, differential diagnosis, approach to history taking and physical examination, and suggested evaluation of the patient with night sweats are discussed here. The management of benign excessive sweating (idiopathic hyperhidrosis) is discussed separately. (See "Primary focal hyperhidrosis".)
Night sweats must be distinguished from other disorders of sweating. For the purposes of this discussion, night sweats are drenching sweats that require changing bedclothes. This more strict definition excludes patients with a benign increase in sweating, or hyperhidrosis. An overheated room or too many bed coverings may be a simple cause for an increase in sweating at night.
Hot flashes are often difficult to distinguish from night sweats, although the former have several distinctive features. Hot flashes may begin with an unpleasant sensation in the chest, breasts, or abdomen. A sudden warmth, and visible skin redness in the chest, head, and neck follows, which may be apparent to observers . The warmth lasts for three to four minutes and is followed by sweating in the same areas. (See "Menopausal hot flashes".)
Flushing, a feature of carcinoid and an adverse effect of certain medications, is a warmth and redness of the face and occasionally the trunk. In practice, it may be difficult to distinguish flushing or increased sweating from night sweats. Thus, the conditions associated with any of these symptoms are discussed below.
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- - Lymphoma
- - Solid tumors
- - Tuberculosis
- - Brucellosis
- - Bacterial infections
- - HIV infection
- - Antidepressants
- - Antipyretics
- - Cholinergic agonists
- - Hypoglycemic agents
- - Hormonal agents
- - Other medications causing flushing
- - Other medications causing sweating
- Endocrine disorders
- - Pheochromocytoma
- - Carcinoid syndrome
- - Hyperthyroidism
- Neurologic disorders
- Idiopathic hyperhidrosis
- Sleep disorders
- Miscellaneous causes
- CLINICAL EVALUATION
- Physical examination
- Diagnostic strategies
- SUMMARY AND RECOMMENDATIONS