Night Sweats

Night sweats are a common complaint in primary care medicine. Different authors define night sweats variably, but this term generally pertains to drenching sweats at night that are not caused by excessive room temperature or clothing/covering.

Differential Diagnosis

• Infections
  –HIV
  –Tuberculosis
  –Infectious mononucleosis
  –Fungal (e.g., histoplasmosis, coccidioidomycosis)
  –Lung or other abscess
  –Endocarditis
  –Osteomyelitis
• Neoplasms
  –Leukemia
  –Hodgkin's disease and other forms of lymphoma
  –Solid tumors (e.g. prostate, adrenal, renal, testicular)
• Menopause/premature ovarian failure
• Hyperthyroidism
• Diabetes mellitus (nocturnal hypoglycemia)
• GERD
• Obstructive sleep apnea
• Chronic fatigue syndrome
• Anxiety
• Pregnancy
• Drugs [e.g., antipyretics (most common), antihypertensives, phenothiazines, antiretroviral agents]
• Substance abuse (including alcohol)
• Orchiectomy
• Endocrine tumors
  –Pheochromocytoma
  –Carcinoid
• Chronic eosinophilic pneumonia
• Prinzmetal's angina
• Temporal arteritis
• Takayasu's arteritis

Workup and Diagnosis

• Complete history and physical examination
  –Note associated symptoms, such as flushing, pain, and tachycardia
  –Review full past medical and social history; review of systems
  –Complete physical with focus on endocrine, lymphatic, and dermatologic systems
• Laboratory testing depends on the presumed etiology; a reasonable initial workup includes CBC with differential, eosinophil count, electrolytes, BUN/creatinine, calcium, magnesium, TSH, urinalysis and culture, and ESR
• Consider the following testing if indicated: FSH (perimenopause), PPD, chest X-ray, HIV viral load/antibody, blood cultures, monospot, 3 AM glucose level to assess for nocturnal hypoglycemia, sleep study, free T4, 24-hour urinary catecholamines, 5-hydroxyindoleacetic acid, echocardiogram, and/or CT of chest/abdomen/pelvis

Treatment

• Treatment depends on etiology, although identifying the correct diagnosis is usually the most difficult aspect of the disease
• Treating the appropriate condition if amenable to therapy will relieve the night sweats
• Antipyretics (e.g., ibuprofen, acetaminophen)
• Cessation of substance abuse
• Appropriate antimicrobials if infectious cause
• Cessation or decreased dose of causative medication(s), if possible

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Night sweats

Read excerpts from these other book chapters related to Night sweats:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Night sweats

• Back to symptom: Night sweats: Introduction (review 189 causes)
• Next Book Extract About Night sweats: Night Sweats (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Night sweats

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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