Symptom finder - The causes of sweating abnormalities
Symptom finder - The causes of sweating abnormalities
Abnormalities of sweating can be divided into deficient sweating and excessive sweating. Deficient sweating is caused by sympathetic tract lesions, hypohidrotic ectodermal dysplasia, miliaria and heat stroke. Excessive sweating is caused by psychiatric disorder such as anxiety or substance withdrawal and substance abuse, endocrine disorder such as phaeochromocytoma, carcinoid syndrome, thyrotoxicosis, menopause and diabetic autonomic neuropathy, malignancy such as Hodgkin’s disease /lymphoma and brain tumors, infection ( systemic infection) and metabolic disorder such as hyperglycemia.
Deficient sweating is a rare condition . The most common causes are heat stroke or hypohidrotic ectodermal dysplasia ( congenital disorder of the sweat gland ), a condition due to poor teeth and hair formation.Rupture and plugging of the sweat ducts or miliaria may also contribute to deficient sweating.
Physiological state that occur with shock, nausea, pain and vomiting are the most common cause of excessive sweating . Hypoglycemic patient may suffer from episodic bouts of sweating besides, hunger, anxiety, dizziness and tremor. Phaeochromocytoma is associated with paroxysmal release of catecholamines which lead to episodic bout of sweating and carcinoid syndrome is associated with secretion of varieties of hormones by enterochromaffin tumors. These tumors originates from small bowel in the present of any metastasis to the hepatic/liver. Besides sweating, other signs are wheezy (right sided heart lesions), diarrhea and brick red flushing.
Menopause reaching women may present with episodic bouts of sweating and hot flushes due to alteration of the female reproductive hormone concentration.
In certain cases, patient complains of clothes and bed sheet drenched with sweat after waking up ( night sweat0. Night sweat is associated with Hodgkin’s disease and tuberculosis. Malaise, fever, pruritus, weight loss and localized lymphadenopathy are associated symptoms of Hodgkin’s lymphoma while hemoptysis, weight loss and cough are associated with tuberculosis. Urgent investigations are require in both conditions.
Thyrotoxicosis is presented with collection of symptoms such as heat intolerance and constant sweating due to an increase in the metabolic rates. Other signs of thyrotoxicosis are weight loss, increase appetite, palpitations, diarrhea and emotional lability. Tumor encroaching the hypothalamus may also cause excessive sweating ( rare condition). Drug history should be taken and focus on any substance dependency because severe case of sweating and hallucinations may occur in withdrawal states.
Psychological evaluation is performed in anxiety disorder. Generally raised temperature or pyrexia will be associated with infection or Hodgkin’s disease. On inspection, carcinoid syndrome is typically presented with episodes of brick red flushing of the face. Graves’s disease may present with ophthalmoplegia or exophthalmos. Thyrotoxicosis may present with sweating, lid lag and wide staring eyes.
Always examined the regional lymph node to rule out any enlargement due to malignancy or infection. Thyroid gland is palpated to feel for any enlargement. Systemic infection and thyrotoxicosis as well as paroxysmal attack of phaeochromocytoma may present with tachycardia. Phaeochromocytoma may also present with hypertension. Collapse of a segment of lung or pleural effusion may be the only sign of primary pulmonary tuberculosis. Endocarditis is characterized by the onset of new murmur. Carcinoid syndrome is associated with pulmonary stenosis, pulmonary regurgitation, aortic stenosis and aortic regurgitation. Hodgkin’s disease may present with splenomegaly.
Abnormalities of sweating can be divided into deficient sweating and excessive sweating. Deficient sweating is caused by sympathetic tract lesions, hypohidrotic ectodermal dysplasia, miliaria and heat stroke. Excessive sweating is caused by psychiatric disorder such as anxiety or substance withdrawal and substance abuse, endocrine disorder such as phaeochromocytoma, carcinoid syndrome, thyrotoxicosis, menopause and diabetic autonomic neuropathy, malignancy such as Hodgkin’s disease /lymphoma and brain tumors, infection ( systemic infection) and metabolic disorder such as hyperglycemia.
Deficient sweating is a rare condition . The most common causes are heat stroke or hypohidrotic ectodermal dysplasia ( congenital disorder of the sweat gland ), a condition due to poor teeth and hair formation.Rupture and plugging of the sweat ducts or miliaria may also contribute to deficient sweating.
Physiological state that occur with shock, nausea, pain and vomiting are the most common cause of excessive sweating . Hypoglycemic patient may suffer from episodic bouts of sweating besides, hunger, anxiety, dizziness and tremor. Phaeochromocytoma is associated with paroxysmal release of catecholamines which lead to episodic bout of sweating and carcinoid syndrome is associated with secretion of varieties of hormones by enterochromaffin tumors. These tumors originates from small bowel in the present of any metastasis to the hepatic/liver. Besides sweating, other signs are wheezy (right sided heart lesions), diarrhea and brick red flushing.
Menopause reaching women may present with episodic bouts of sweating and hot flushes due to alteration of the female reproductive hormone concentration.
In certain cases, patient complains of clothes and bed sheet drenched with sweat after waking up ( night sweat0. Night sweat is associated with Hodgkin’s disease and tuberculosis. Malaise, fever, pruritus, weight loss and localized lymphadenopathy are associated symptoms of Hodgkin’s lymphoma while hemoptysis, weight loss and cough are associated with tuberculosis. Urgent investigations are require in both conditions.
Thyrotoxicosis is presented with collection of symptoms such as heat intolerance and constant sweating due to an increase in the metabolic rates. Other signs of thyrotoxicosis are weight loss, increase appetite, palpitations, diarrhea and emotional lability. Tumor encroaching the hypothalamus may also cause excessive sweating ( rare condition). Drug history should be taken and focus on any substance dependency because severe case of sweating and hallucinations may occur in withdrawal states.
Psychological evaluation is performed in anxiety disorder. Generally raised temperature or pyrexia will be associated with infection or Hodgkin’s disease. On inspection, carcinoid syndrome is typically presented with episodes of brick red flushing of the face. Graves’s disease may present with ophthalmoplegia or exophthalmos. Thyrotoxicosis may present with sweating, lid lag and wide staring eyes.
Always examined the regional lymph node to rule out any enlargement due to malignancy or infection. Thyroid gland is palpated to feel for any enlargement. Systemic infection and thyrotoxicosis as well as paroxysmal attack of phaeochromocytoma may present with tachycardia. Phaeochromocytoma may also present with hypertension. Collapse of a segment of lung or pleural effusion may be the only sign of primary pulmonary tuberculosis. Endocarditis is characterized by the onset of new murmur. Carcinoid syndrome is associated with pulmonary stenosis, pulmonary regurgitation, aortic stenosis and aortic regurgitation. Hodgkin’s disease may present with splenomegaly.
The laboratory investigations are full blood count, ESR, CRP, blood film, BM stix, chest X ray, TSH, free T4, Mantoux test / ELIspot assay, MRI head, lymph node excision biopsy , urinary catecholamines and metanephrines and urinary 5HIAA.
Full blood count and blood film may reveal increase in white cell count in infection. CRP and ESR are raised with lymphoma ( malignancy) and infection. BM stix is useful in assessment of blood sugar level rapidly which is then confirmed with blood glucose measurements. Phaeochromocytoma may also present with raised glucose. Chest x ray is useful to identify any chest infection, bronchial carcinoid and tuberculosis. Thyrotoxicosis may present with raised T4 and low TSH.Mantoux test ( diluted Mantoux test ) is useful for screening of tuberculosis in no previous BCG immunization patient. ELISpot assay is a serological test for tuberculosis. Any hypothalamic tumor is detected by MRI of the head. Hodgkin’s disease is characterized by the present of Reed- Sternberg cells which is detected on lymph node excision biopsy. In phaeochromocytoma , there will be a rise in urinary catecholamines and metanephrines level. Urinary 5HIAA will be high in carcinoid tumor.
Full blood count and blood film may reveal increase in white cell count in infection. CRP and ESR are raised with lymphoma ( malignancy) and infection. BM stix is useful in assessment of blood sugar level rapidly which is then confirmed with blood glucose measurements. Phaeochromocytoma may also present with raised glucose. Chest x ray is useful to identify any chest infection, bronchial carcinoid and tuberculosis. Thyrotoxicosis may present with raised T4 and low TSH.Mantoux test ( diluted Mantoux test ) is useful for screening of tuberculosis in no previous BCG immunization patient. ELISpot assay is a serological test for tuberculosis. Any hypothalamic tumor is detected by MRI of the head. Hodgkin’s disease is characterized by the present of Reed- Sternberg cells which is detected on lymph node excision biopsy. In phaeochromocytoma , there will be a rise in urinary catecholamines and metanephrines level. Urinary 5HIAA will be high in carcinoid tumor.
