From the Guidelines
The evaluation of night sweats should begin with a thorough history and physical examination, including determination of B symptoms, to identify potential causes, as recommended by the most recent guidelines 1. The initial assessment should include a comprehensive medical history, physical examination, and laboratory tests to identify potential underlying causes of night sweats.
- The history should include questions about the frequency, severity, and duration of night sweats, as well as associated symptoms like fever, weight loss, cough, or joint pain.
- Review of medications, as some drugs like antidepressants, hormone therapies, and antipyretics can cause night sweats.
- Physical examination should include vital signs, lymph node assessment, and cardiopulmonary examination.
- Initial laboratory tests should include complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, thyroid function tests, and HIV testing, as suggested by the guidelines 1. If tuberculosis is suspected, obtain a tuberculin skin test or interferon-gamma release assay. For persistent unexplained night sweats, consider chest X-ray, CT scan of chest/abdomen/pelvis to evaluate for malignancy or infection, and possibly bone marrow biopsy if blood disorders are suspected, as recommended by the guidelines 1. Night sweats can result from various conditions including infections (tuberculosis, HIV, endocarditis), malignancies (lymphoma, leukemia), endocrine disorders (hyperthyroidism, pheochromocytoma), menopause, medications, or idiopathic hyperhidrosis. Treatment should target the underlying cause rather than just symptomatically managing the sweating. For idiopathic cases, consider moisture-wicking bedding, keeping the bedroom cool, avoiding alcohol and spicy foods before bedtime, and in severe cases, medications like anticholinergics (glycopyrrolate 1-2mg daily) or certain antidepressants (venlafaxine 37.5-150mg daily) may help reduce sweating.
From the Research
Night Sweats
- Night sweats are a nonspecific symptom that can be caused by various conditions, including menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity 2.
- A systematic and cost-conscious strategy should be used to evaluate night sweats, including laboratory and imaging studies such as a complete blood count, tuberculosis testing, thyroid-stimulating hormone levels, HIV testing, C-reactive protein level, and chest radiography 2, 3.
- Additional tests that could be considered selectively include computed tomography of the chest and/or abdomen, bone marrow biopsy, polysomnography, and/or additional laboratory studies if indicated 2, 3.
- The presence of night sweats alone does not indicate an increased risk of death, and reassurance and continued monitoring are recommended if no underlying disorder is suspected 2, 4.
Diagnostic Evaluation
- A thorough history and physical examination are essential in evaluating night sweats, and can help identify potential causes such as infection, malignancies, sleeping disorders, and medication-related causes 5, 3.
- A screening for infections, sleeping disorders, and a medication review are necessary for every patient with night sweats 5.
- Diagnostic clues, such as the presence of fever, can help guide the evaluation and management of night sweats 5.
Management
- Treatment for night sweats should be directed at the underlying cause, if identified 2.
- Alpha adrenergic blockers may reduce night sweats in patients taking serotonin reuptake inhibitors, and thalidomide and thioridazine may benefit some terminal cancer patients with night sweats 4.
- Reassurance and continued monitoring are recommended if no underlying disorder is suspected, as the symptom of night sweats appears to be nonspecific and many questions about causation, evaluation, and management remain unanswered 2, 4.