Sleep hyperhidrosis: Difference between revisions

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The condition may be considered a [[sign (medicine)|sign]] of various [[disease]] states, including:
The condition may be considered a [[sign (medicine)|sign]] of various [[disease]] states, including:


* [[Alcohol withdrawal]]
* [[Anxiety disorder]]
* [[B symptoms]]
* [[Benzodiazepine]] withdrawal
* [[Beryllium]]
* [[Blastomycosis]]
* [[Brucellosis]]
* [[Cancer]]
* [[Cerebral palsy]]
* [[Chromium deficiency]]
* [[Chronic eosinophilic pneumonia]]
* [[Chronic fatigue syndrome]]
* [[Telencephalon|Cerebral]] and [[brain stem]] [[stroke]]s
* [[Diabetes]]
* [[Drugs]] side effects
:*[[Abatacept Injection (patient  information)]]
:*[[Adalimumab Injection (patient  information)]]
:*[[Camphoric acid]]
:*[[Creeping Cinquefoil]]
:*[[Cyclosporine (patient information)]]
:*[[Estroven]]
:*[[Imatinib (patient information)]]
:*[[Lamotrigine]]
:*[[Letrozole (patient information)]]
:*[[Leuprolide (patient information)]]
:*[[Levomepromazine]]
:*[[Natalizumab injection (patient  information)]]
:*[[Pegaspargase (patient information)]]
:*[[Pentamidine Inhalation (patient  information)]]
:*[[Rituximab injection (patient  information)]]
:*[[Sertraline]]
:*[[Trenbolone]]
* [[Eosinophilic pneumonia]]
* [[Eosinophilic pneumonia]]
* [[Epilepsy]]
* [[Epilepsy]]
Line 112: Line 80:
* [[Waldenstrom's macroglobulinemia]]
* [[Waldenstrom's macroglobulinemia]]
* Warm bedroom
* Warm bedroom
==Differential diagnosis of sleep hydrosis==
(By organ system)
{|style="width:75%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | • [[Prinzmetal's angina]] • [[Subacute endocarditis]] • [[Takayasu's arteritis]] •[[Temporal arteritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| • [[Alcohol withdrawl]] • [[Benzodiazepine]] withdrawl • [[Opiate]] withdrawl •
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| • [[Beryllium]] • [[Abatacept Injection (patient  information)]] • [[Adalimumab Injection (patient  information)]] • [[Camphoric acid]] • [[Creeping Cinquefoil]] • [[Cyclosporine (patient information)]] • [[Estroven]] • [[Imatinib (patient information)]] • [[Lamotrigine]] • [[Letrozole (patient information)]] • [[Leuprolide (patient information)]][[Levomepromazine]] • [[Natalizumab injection (patient  information)]] • [[Pegaspargase (patient information)]] • [[Pentamidine Inhalation (patient  information)]] • [[Rituximab injection (patient  information)]] • [[Sertraline]] • [[Trenbolone]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| • [[Diabetes] • [[Hyperthyroidism]] • [[Hypoglycemia]] • [[Hypothalamus|Hypothalamic]] lesions
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| • [[]] • [[Gastroesophageal reflux disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|  • [[Polycythemia vera]] • [[Waldenstrom's macroglobulinemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| • [[Orchiectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| • [[Lung abscess]] • [[Mononucleosis]] • [[Mycobacterium avium complex infection]] • [[Nocardiosis]] • [[Blastomycosis]] • [[Brucellosis]] • [[Chronic eosinophilic pneumonia]] • [[Eosinophilic pneumonia]] • [[Fungal infection]] • [[HIV]] • [[Osteomyelitis]] • [[Pneumocystis pneumonia]] • [[Histomplasmosis]] • [[Relapsing fever]] • [[Tuberculosis]] • [[Urinary tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| • [[Osteotomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| • [[Cerebral palsy]] • [[Telencephalon|Cerebral]] and [[brain stem]] [[stroke]]s • [[Epilepsy]] • [[Familial dysautonomia]] •
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| •
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| • [[Menopause]] • [[]] • [[Ovarian hyperstimulation syndrome]] • [[Pregnancy]] • [[Premature ovarian failure]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|  • [[Lymphoma]] • [[Mantle cell lymphoma]] • [[B symptoms]] • [[Occult malignancy]] • [[Hodkin's disease]] • [[Leukemia]] • [[            Normal.dotm  0  0  1  44  252  kashish85  2  1  309  12.0        0  false      18 pt  18 pt  0  0    false  false  false                            Solid tumors]]<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>   
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Substance abuse]] •
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| • [[Anxiety|Anxiety disorders]] •
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| • [[Asthma]] • [[Obstructive sleep apnea]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| •
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|  • [[Kikuchi disease]] • [[]] •
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|  • [[Head injury]] • [[]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| • [[Chronic fatigue syndrome]] • [[Excess bed covers]] • [[Tree marigold]] • [[Warm bedroom]]
|-
|}


==Diagnosis==
==Diagnosis==

Revision as of 20:15, 12 May 2012

Sleep hyperhidrosis
ICD-10 R61.9
ICD-9 780.8, 327

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake. A night sweat caused by a medical condition or infection can be described as ‘severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment’. [2] True night sweats with medical causes should be properly investigated by a medical physician.

Classification of Sweating

There are four types of sweats:

  1. Diaphoresis: Diaphoresis is a cold sweat. Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. It is distinguished from hyperhidrosis by the "clammy" or "cold state" state of the patient.
  2. Primary Hyperhidrosis: Primary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. This is not a cold sweat.
  3. Secondary Hyperhidrosis: Secondary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature that is secondary to an underlying pathologic process such as infections, disorders of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. This is not a cold sweat.
  4. Night sweats: Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake.

Epidemiology and Demographics

Sleep hyperhidrosis may occur at any age, but is most commonly seen in early adulthood.

Genetics

Night sweats may occur for genetic reasons and may be relatively harmless. However, they can be distressing and disrupt sleep patterns if severe; the patient may be frequently awakened due to the discomfort of damp sleepwear.

Natural History, Complications and Prognosis

While some causes of night sweats, such as menopause, may be relatively harmless, night sweats may also be a sign of a serious underlying disease.

Causes

Common Causes

One of the most common causes of night sweats in women over 40 is the hormonal changes related to menopause and perimenopause. This is a normal part of menopause and while annoying, it is not necessarily dangerous or a sign of underlying disease. Some women experience night sweats during pregnancy due to hormonal changes.

While there can be many causes of excessive sweating at night including the menopause and, for example, a bedroom that is unusually hot or too many bed clothes on the bed, it is important to distinguish night sweats that arise due to medical causes from those that occur because the sleep environment is too warm.

Complete differential diagnosis of causes of Sleep hyperhidrosis in alphabetical order

The condition may be considered a sign of various disease states, including:


Differential diagnosis of sleep hydrosis

(By organ system)

Cardiovascular • Prinzmetal's angina • Subacute endocarditis • Takayasu's arteritis •Temporal arteritis
Chemical / poisoning • Alcohol withdrawl • Benzodiazepine withdrawl • Opiate withdrawl •
Drug Side Effect • Beryllium • Abatacept Injection (patient information) • Adalimumab Injection (patient information) • Camphoric acid • Creeping Cinquefoil • Cyclosporine (patient information) • Estroven • Imatinib (patient information) • Lamotrigine • Letrozole (patient information) • Leuprolide (patient information)Levomepromazine • Natalizumab injection (patient information) • Pegaspargase (patient information) • Pentamidine Inhalation (patient information) • Rituximab injection (patient information) • Sertraline • Trenbolone
Endocrine • [[Diabetes] • Hyperthyroidism • Hypoglycemia • Hypothalamic lesions
Gastroenterologic • [[]] • Gastroesophageal reflux disease
Genetic
Hematologic • Polycythemia vera • Waldenstrom's macroglobulinemia
Iatrogenic • Orchiectomy
Infectious Disease • Lung abscess • Mononucleosis • Mycobacterium avium complex infection • Nocardiosis • Blastomycosis • Brucellosis • Chronic eosinophilic pneumonia • Eosinophilic pneumonia • Fungal infection • HIV • Osteomyelitis • Pneumocystis pneumonia • Histomplasmosis • Relapsing fever • Tuberculosis • Urinary tract infection
Musculoskeletal / Ortho • Osteotomy
Neurologic • Cerebral palsy • Cerebral and brain stem strokes • Epilepsy • Familial dysautonomia •
Nutritional / Metabolic •
Obstetric/Gynecologic • Menopause • [[]] • Ovarian hyperstimulation syndrome • Pregnancy • Premature ovarian failure
Oncologic • Lymphoma • Mantle cell lymphoma • B symptoms • Occult malignancy • Hodkin's disease • Leukemia • Normal.dotm 0 0 1 44 252 kashish85 2 1 309 12.0 0 false 18 pt 18 pt 0 0 false false false Solid tumors[3] [4]
Overdose/Toxicity Substance abuse •
Psychiatric • Anxiety disorders •
Pulmonary • Asthma • Obstructive sleep apnea
Renal / Electrolyte •
Rheum / Immune / Allergy • Kikuchi disease • [[]] •
Trauma • Head injury • [[]]
Miscellaneous • Chronic fatigue syndrome • Excess bed covers • Tree marigold • Warm bedroom

Diagnosis

History and Symptoms

  • History:
  • Medical history should focus on potential infectious and oncologic causes
  • Social history should focus on substance abuse and travel

Physical Examination

  • Full exam with focus on endocrine, dermatologic and lymphatic systems

Echocardiogram

An echocardiogram can be obtained if there is a high suspicion of endocarditis

Laboratory Findings

The folowing laboratory studies may be of use in determining the underlying cause of nightsweats.

More sophisticated laboratory studies would include the following:

MRI and CT

  • Suggest MRI/CT if necessary (chest/abdomen/pelvis)

Treatment

Treat the underlying etiology with appropriate therapy

Acute Pharmacotherapies

  • Ibuprofen or acetaminophen
  • Antimicrobial if infection is the cause

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

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