night sweats

Introduction

Perspiration during sleep at night of sufficient magnitude as to necessitate a change in bed clothing &/or bedding (sheets).

Etiology

• malignancy
  • lymphoma
    • non-Hodgkin's lymphoma
    • Hodgkin's disease*
  • solid tumors
    • germ cell tumors
    • medullary carcinoma of the thyroid
    • prostate cancer
    • renal cell carcinoma
    • others
• infections
  • mycobacterial
    • tuberculosis*
    • atypical mycobacteria
  • bacterial
    • abscess
    • endocarditis
    • osteomyelitis
  • viral
    • HIV
• medications
• substance withdrawal
  • alcohol, cocaine, opiates
• endocrine disorders
  • carcinoid syndrome*
  • diabetes insipidus
  • hyperthyroidism
  • hypoglycemia
  • pheochromocytoma
  • post orchiectomy
• menopause
• neurologic disorders
  • autonomic dysreflexia
  • autonomic neuropathy
  • post-traumatic syringomyelia
  • stroke
• miscellaneous
  • chronic fatigue syndrome
  • gastoesophageal reflux
  • mastocytosis
  • panic disorder
  • rosacea
  • sleep apnea
  • temporal arteritis
  • idiopathic hyperhidrosis
• children
  • 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

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

Diagnostic procedures

• PPD

Radiology

chest X-ray, CT of thorax & abdomen

Differential diagnosis

• idiopathic hyperhidrosis
• flushing
• post-menopausal hot flashes

Management

• exclude fever
• when possible, discontinue medications
• empiric therapy not recommended

More general terms

• hyperhidrosis

Additional terms

• diaphoresis
• perspiration (sweating)