One reasonable algorithm recommends an initial work-up including a complete blood count, thyroid-stimulating hormone (TSH) and erythrocyte sedimentation rate (ESR) level, a purified protein derivative (PPD) and HIV test, and a chest x-ray.5 If the results are unrevealing, a trial of antireflux medication is recommended. If the patient does not improve, consider a diary of nocturnal temperatures to help discern the presence or absence of febrile pulses and further evaluate for suspected endocarditis or lymphoma.
TABLE 2
Differential diagnosis for night sweats
| ENDOCRINE |
| Carcinoid syndrome |
| Diabetes insipidus |
| Hyperthyroidism |
| Hypoglycemia |
| Pheochromocytoma |
| Post-orchiectomy |
| INFECTIONS |
| Coccidioidomycosis |
| Endocarditis |
| Histoplasmosis |
| Human immunodeficiency virus |
| Infectious mononucleosis |
| Lung abscess |
| Mycobacterium avium complex |
| Osteomyelitis |
| Tuberculosis |
| MALIGNANCY |
| Leukemia |
| Lymphoma |
| Prostate cancer |
| Renal cell carcinoma |
| Other neoplasms |
| NEUROLOGIC DISORDERS |
| Autonomic dysreflexia |
| Autonomic neuropathy |
| Stroke |
| SUBSTANCE WITHDRAWAL |
| Alcohol |
| Cocaine |
| Opioids |
| MISCELLANEOUS |
| Chronic fatigue syndrome |
| Gastroesophageal reflux disease |
| Menopause |
| Obstructive sleep disorder |
| Panic disorder |
| Pregnancy |
| Prinzmetal’s angina |
| Takayasu’s arteritis |
| Temporal arteritis |
| Source: UpToDate;4 viera et al, Am Fam Physician 2003;5 Chambliss, Arch Fam Med 1999.6 |
Evidence is scant for symptom relief
Very few clinical trials have directly studied symptomatic relief of night sweats. A large Cochrane meta-analysis found that oral hormone therapy—estrogens alone or estrogens with progesterone—reduced the frequency of night sweats associated with hot flashes among menopausal women by 75% when compared with placebo alone.7 Neither primrose oil nor foot reflexology proved effective.8
A cohort study found that 80% of the patients with frequent night sweats responded to antireflux therapy.3 One author suggests using therapies aimed at relieving hyperhydrosis.6 These include local treatment with aluminum chloride hexahydrate (Drysol), antiperspirants, scopolamine, or phenoxybenzamine hydrochloride (Dibenzyline).
Recommendations from others
A thorough literature search through Cochrane Database Systematic Reviews, AHRQ, National Guideline Clearing-house, and Medline did not yield any guidelines or consensus statements from other organizations or specialty groups on the evaluation or treatment of night sweats.