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What causes night sweats?

Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions

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Posted on Sat, 27 Sep 2014 in Cancer
Question: I have been having severe night sweats every night, in fact every time I sleep even during the day. I am diabetic, and recently finished treatment for cancer (surgery followed by chemo). My last three quarterly CT scans have been "cancer free." I am taking metformin for diabetes, and have ruled our hypoglycemia as the cause. My glucose levels are consistently elevated, never low. The only other symptom is drowsiness.
doctor
Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer:
Needs workup

Detailed Answer:
Thank you for asking

Night sweats in your case needs to be evaluated for recurrence of cancer or glucose strict monitoring and dose readjustment as low glucose levels may cause such sweats and that odds increase in night.

Once ruled out other options will be considered.

Excessive sweating AKA hyperhidrosis is a wide array of manifestation to many etiologies underlying and need a lot of work up to reach one.This symptom is sweating in excess of that required for normal thermoregulation, is a condition that usually begins in either childhood or adolescence. Although any site on the body can be affected by hyperhidrosis, the sites most commonly affected are the palms, soles, and axillae. Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Hyperhidrosis exists in 3 forms: emotionally induced hyperhidrosis (in which it affects the palms, soles, and axillae, localized hyperhidrosis, and generalized hyperhidrosis. Hyperhidrosis often causes great emotional distress and occupational disability regardless of the form and it needs to be sorted out.
Following lab work needs to be done to sort out the roots for this excessive sweating
Thyroid function tests may reveal underlying hyperthyroidism or thyrotoxicosis.
Blood glucose levels may reveal diabetes mellitus or hypoglycemia.
Urinary catecholamines may reveal a possible pheochromocytoma.
Uric acid levels may reveal gout.
A purified protein derivative (PPD) test can be performed to screen for tuberculosis.
Chest radiography may be used to rule out tuberculosis or a neoplastic cause of the hyperhidrosis.
Consult to a neurologist and endocrinologist and discuss the different management plans from conservative to interventional like topical agents as anticholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization), glutaraldehyde, and methenamine,Drysol (20% aluminum chloride hexahydrate in absolute anhydrous ethyl alcohol),topical application of baking soda,aluminium chloride gel are to be discussed
Systemic agents as anticholinergic medications such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine. Also sedatives and tranquilizers, indomethacin, and calcium channel blockers are also useful.
Iontophoresis (passing a direct current across the skin) Also works like charm, so does botulinum toxin.
last but not the least is the surgical parasympathectomy if the above mentioned maneuvers fail

I hope it helps. Take good care of yourself and don't forget to close the discussion please.

May the odds be ever in your favour.

Regards XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan 5 hours later
Please simplify your answer to a layperson's level of understanding. In addition,

1. Please note that hypoglycemia has been ruled out. My glucose levels are running high, including during sweating episodes. They are never low.

2. I just visited my oncologist 2 weeks ago at one of the world's leading cancer centers. Had a thorough exam and went over negative full body CT scan. Had comprehensive blood tests. There were no indications of cancer recurrence. What further "work up" would you suggest to determine whether cancer has recurred?

3. Please limit your diagnosis to my actual, not theoretical symptoms. Are there any conditions I might have with no fever, no sore throat, etc., but only profuse sweating upon going to sleep (day or night), and drowsiness as the symptoms? Do you have any questions for me that might assist in your differential diagnosis?

4. One additional fact that might be relevant to your diagnosis: I started on a walking program to regain my strength after months of chemo. I probably over exerted, going up a steep hill, resulting in a very high heart rate. Came home exhausted. The night sweats started the next day and have not stopped for the last 5 days.

doctor
Answered by Dr. Shafi Ullah Khan 3 hours later
Brief Answer:
Anxiety, sleep disorder, thyroid, infection

Detailed Answer:
Thank you for getting back to me
Now that glucose levels and cancer recurrence has been rule dout next step is to find out the further work up.

Sudden and abrupt start after a trip of exertion activity may need to rule out infections like tuberculosis but start that abrupt is not possible. But there is no harm in getting evaluated.

The medication you use for diabetes itself can cause sweating and shifting time of medicine intake may cause it.

Anxiety or depression or any medications for such troubles may cause that too.

Thyroid hormones assessment may also be needed.
But just 5 days history of such symptoms make them likely an infection.

Sleep disorders and disturbances in such steep hilly walks are common and may result in such sweating episodes.

SOme other possibilities for night sweats are mentioned below.

Medications that can cause night sweats

Night sweats are a common side effect of many medications, such as:

Depression medications (antidepressants)
Drugs used to regulate your hormones (hormone therapy)
Drugs that lower the level of sugar in your blood (hypoglycemic agents)
Medical conditions that can cause night sweats

Diseases and conditions that can cause night sweats include:

Anxiety
Autonomic neuropathy (damage to your autonomic nerves)
Brucellosis (a bacterial infection)
Carcinoid syndrome (a syndrome resulting from a certain type of cancerous tumor)
Endocarditis (an infection of your heart lining)
HIV/AIDS
Hodgkin's lymphoma (Hodgkin's disease)
Hyperthyroidism (overactive thyroid)
Leukemia
Menopause
Myelofibrosis (a bone marrow disorder)
Non-Hodgkin's lymphoma
Osteomyelitis (a bone infection)
Pheochromocytoma (a rare adrenal gland tumor)
Pyogenic abscess (a pus-filled cavity caused by an infection)
Sleep disorders (such as obstructive sleep apnea)
Stroke
Syringomyelia (a fluid-filled cyst in the spinal cord)
Tuberculosis

Please seek an internal medicine specialist and let them correlate it clinically for you.

I hope it helps.
Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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