Differential Diagnosis for Excessive Sweating in a 72-year-old Woman

Single Most Likely Diagnosis

• Hyperhidrosis: This is a common condition characterized by excessive sweating, often affecting the palms, soles, and axillae. It can be primary (idiopathic) or secondary to other conditions. Given the age and presentation, primary hyperhidrosis or hyperhidrosis secondary to menopause are plausible.

Other Likely Diagnoses

• Menopause: Hormonal changes during menopause can lead to hot flashes and night sweats, which are forms of excessive sweating.
• Medication Side Effects: Many medications, including antidepressants, antipsychotics, and certain blood pressure medications, can cause excessive sweating as a side effect.
• Hypothyroidism: Although less common, hypothyroidism can cause excessive sweating among other symptoms like weight gain and fatigue.
• Anxiety or Stress: Psychological factors can lead to excessive sweating, especially if the patient experiences anxiety or stress.

Do Not Miss Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause excessive sweating, hypertension, and tachycardia. Although rare, it's critical to diagnose due to its potential severity.
• Hyperthyroidism: An overactive thyroid gland can cause excessive sweating, weight loss, and palpitations. Missing this diagnosis could lead to significant morbidity.
• Infections: Certain infections, such as tuberculosis or endocarditis, can present with night sweats among other symptoms.
• Lymphoma: Some types of lymphoma can cause night sweats, which is one of the "B symptoms" (along with fever and weight loss) that indicate a more severe disease.

Rare Diagnoses

• Carcinoid Syndrome: A rare condition caused by a neuroendocrine tumor that can lead to excessive sweating, flushing, and diarrhea.
• Autonomic Dysfunction: Conditions affecting the autonomic nervous system, such as multiple system atrophy, can cause abnormal sweating patterns.
• Gustatory Sweating (Frey's Syndrome): A rare condition where sweating and flushing of the skin occur in response to the sight, smell, or taste of food, often after trauma to the parotid gland or its surrounding tissues.

Each of these diagnoses should be considered based on the patient's full clinical presentation, medical history, and additional diagnostic tests as necessary.