From the Guidelines
Night sweats without other constitutional symptoms require a thorough evaluation to identify the underlying cause, starting with a detailed history and physical examination, followed by initial laboratory testing including complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, thyroid function tests, and HIV testing, as recommended by various studies 1.
Initial Evaluation
The initial evaluation should focus on identifying potential causes of night sweats, including:
- Medication use, such as antidepressants or hormone therapies
- Alcohol consumption
- Menopausal status in women
- Anxiety disorders
- Idiopathic hyperhidrosis
Laboratory Testing
Initial laboratory testing should include:
- Complete blood count
- Comprehensive metabolic panel
- Erythrocyte sedimentation rate
- C-reactive protein
- Thyroid function tests
- HIV testing
Additional Testing
If the initial laboratory tests are unremarkable, consider additional testing, such as:
- Chest X-ray to rule out pulmonary pathology
- Tuberculosis screening with interferon-gamma release assay
- Serum protein electrophoresis to evaluate for multiple myeloma
- CT imaging of the chest, abdomen, and pelvis to rule out occult malignancy
Referral to Specialists
If night sweats are severe or persistent despite negative initial workup, referral to appropriate specialists, such as hematology, infectious disease, or endocrinology, may be warranted.
Treatment
Treatment should target the underlying cause when identified, but for idiopathic night sweats, moisture-wicking bedding, keeping the bedroom cool, and avoiding alcohol or spicy foods before bedtime may provide symptomatic relief, as suggested by studies 1. The most recent and highest quality study 1 emphasizes the importance of excluding active tuberculosis in cancer patients, which may also be relevant to the evaluation of night sweats in other contexts.
From the Research
Night Sweats Workup
When a patient presents with night sweats and no other constitutional symptoms, a thorough workup is necessary to determine the underlying cause.
- The workup may include a thorough history, physical examination, and directed laboratory and radiographic studies 2.
- Laboratory tests such as a complete blood count, purified protein derivative, human immunodeficiency virus test, thyroid-stimulating hormone test, and erythrocyte sedimentation rate evaluation may be considered 2, 3.
- Imaging studies such as a chest radiograph, and possibly chest and abdominal computed tomographic scans may also be necessary 2, 3.
- If the initial workup is normal, and no additional disorders are suspected, reassurance and continued monitoring are recommended 3.
Differential Diagnosis
The differential diagnosis for night sweats is broad and includes:
- Infections such as tuberculosis and Mycobacterium bovis 2, 4
- Malignancies such as lymphoma 2
- Endocrine disorders such as hyperthyroidism 2, 3
- Gastroesophageal reflux disease 2, 3
- Obstructive sleep apnea 2
- Medications and drugs of abuse 2
- Menopause and mood disorders 5, 3
Clinical Reasoning
Clinical reasoning is essential in the evaluation of night sweats, as the symptom can be nonspecific and the underlying cause may not be immediately apparent 6.
- A systematic and cost-conscious approach to the workup is necessary, taking into account the patient's history, physical examination, and laboratory and imaging results 3.
- The clinician must use their expertise and judgment to determine the best course of action for each individual patient, as the evidence-based recommendations may not always apply 6.