Flushs and Night Sweats

By: Maged Taman

Patient may have flushes alone or sweating alone but commonly have both. The causes are almost the same. Flushing cause increase heat to skin and hence sweating. Mild sweating at night is normal and second to warm room and heavy cloths. Drenching sweats is the one need to be investigated. The most common causes of excessive sweating and flushing are:

Common Blushing: history is straight forward occurs at earlier age and certain social situations or increase ambient heat.

Postmenopausal flushing: around menopause time, excessive sweating with flushing is common, though patient may complain only of one of them. Episodes are usually less than 5 minutes and more frequent at night. Elevated serum FSH.

Hypoglycemia: commonly a diabetic patient on insulin or oral anti diabetics. Patient is tremulous and hungry during episode. Blood sugar is low during attack.

Spices, certain additives: history is straight forward.

Rosacea: face flushing commonly end with rash typical of rosacea.

Medications: occurs after new medicine and stops by stopping the medicine. Triptans, drugs for erectile dysfunction and anti-estoregn or androgen drug. Even Tylenol, ASA and NSAID's can cause sweating.

Substance withdrawal: as with alcohol and narcotics.

Infections: have patient check the temperature and recorded. Signs of infection may be apparent in examination like a heart murmur, lung rales, tender bone...... ESR and CRP are usually high. Check cultures, PPD and chest x-ray. Check for HIV, brucellosis, hepatiits C and other causes of chronic infections according to clinical suspicion. Other imaging according to suspicion also. Bone marrow biopsy may be the last resort.

Hyperthyroidism: increase heart rate and thyroid goiter are common with low TSH and high T4 and T3.

Carcinoid Syndrome: diarrhea and heart murmur are common. 24h-urine shows increase 5-HIAA.

Pheochromocytoma: high blood pressure, palpitation, headache and increase pulse. 24-hour urine collection for metanephrines, and catecholamines.

Cushing Syndrome: flushing is usually persistent rather than episodic and sweating unlikely, moon face, purple stria and muscle weakness are common. 24 h urine cortisol is elevated.

Medullary Thyroid cancer: thyroid lump, FNA and serum calcitonin.

Lymphoma: lymphadenopathy, splenomegally, itching and fever. CT abdomen, pelvis and lung may be needed.

Solid tumors: tumor may be felt. Consider CT abdomen, pelvis and lung.

Neuralgic disorders including stroke, autonomic dysreflexia, autonomic neuropathy.

Idiopathic hyperhidrosis: no cause can be found, a benign condition.

Treament:
Is according to the cause except in primary or idiopathic see under hyperhydrosis in my blog or other websites.