What is the workup for nocturnal hyperhidrosis (drenching night sweats)?

From the Guidelines

The workup for drenching night sweats should begin with a thorough history and physical examination, including determination of B symptoms, and initial laboratory tests such as complete blood count, differential, platelets, erythrocyte sedimentation rate, serum lactate dehydrogenase, albumin, and liver and renal function tests, as recommended by the most recent guidelines 1. The initial evaluation should also include a PET/CT scan (skull base to midthigh or vertex to feet in selected cases) and diagnostic contrast-enhanced CT (neck, chest, abdomen, and pelvis) to identify potential causes of night sweats, such as lymphoma or other malignancies. Key components of the workup include:

• A thorough history and physical examination to identify potential causes of night sweats
• Initial laboratory tests, including:
  • Complete blood count
  • Differential
  • Platelets
  • Erythrocyte sedimentation rate
  • Serum lactate dehydrogenase
  • Albumin
  • Liver and renal function tests
• Imaging studies, including:
  • PET/CT scan
  • Diagnostic contrast-enhanced CT (neck, chest, abdomen, and pelvis) Additional testing may be necessary based on the patient's age, risk factors, and associated symptoms, such as a tuberculosis skin test or interferon-gamma release assay, HIV testing, and chest X-ray. The workup should be tailored to the patient's individual needs and risk factors to efficiently identify the underlying cause of night sweats, which can be caused by infections, malignancies, endocrine disorders, menopause, medications, or other conditions like obstructive sleep apnea, as noted in previous guidelines 1.

From the Research

Workup for Drenching Night Sweats

The workup for drenching night sweats involves a systematic and cost-conscious approach to identify the underlying cause.

• A thorough history and physical examination are essential to identify potential causes such as menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity 2.
• Laboratory and imaging studies may be ordered, including:
  • Complete blood count
  • Tuberculosis testing
  • Thyroid-stimulating hormone levels
  • HIV testing
  • C-reactive protein level
  • Chest radiography
• Additional tests that could be considered selectively include:
  • Computed tomography of the chest and/or abdomen
  • Bone marrow biopsy
  • Polysomnography
  • Additional laboratory studies if indicated 2, 3
• In some cases, night sweats may be a presenting symptom of a serious underlying condition, such as pulmonary embolism 4.
• A systematic review of the literature found that algorithmic approaches to evaluation are not evidence-based, and many questions about causation, evaluation, and management remain unanswered 5.
• The presence of night sweats alone does not indicate an increased risk of death 2, 5.