Differential Diagnosis for Night Sweats and Perimenopause

Single Most Likely Diagnosis

• Perimenopause: This is the most likely diagnosis given the patient's symptoms of night sweats, which are a common symptom of perimenopause due to hormonal fluctuations, particularly the decline in estrogen levels.

Other Likely Diagnoses

• Menopause: Similar to perimenopause, menopause itself can cause night sweats due to the significant drop in estrogen levels.
• Anxiety or Stress: Psychological factors can lead to night sweats, and the emotional changes associated with perimenopause can exacerbate anxiety and stress.
• Sleep Disorders: Conditions like sleep apnea or insomnia can cause night sweats, and these disorders can be more common or exacerbated during perimenopause.
• Hypothyroidism: Although less common, hypothyroidism can cause night sweats among other symptoms like fatigue, weight gain, and cold intolerance.

Do Not Miss Diagnoses

• Tuberculosis (TB): Although rare in many parts of the world, TB can cause night sweats and would be catastrophic if missed.
• Lymphoma: Certain types of lymphoma can present with night sweats, among other symptoms like weight loss and fever.
• Hyperthyroidism: An overactive thyroid gland can lead to night sweats, weight loss, and other symptoms.
• Diabetes: Uncontrolled diabetes can lead to night sweats, among many other symptoms.

Rare Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause night sweats, hypertension, and other symptoms.
• Carcinoid Syndrome: A rare condition caused by a neuroendocrine tumor that can lead to night sweats, flushing, and diarrhea.
• Hypogonadism: Although more common in men, hypogonadism (low testosterone) can also occur in women and might lead to night sweats among other symptoms.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and appropriate diagnostic testing to determine the underlying cause of her symptoms.