Secondary hyperhidrosis refers to excessive sweating caused by an underlying disease or injury. Identifying the cause will often determine the optimum management for the sweating.
Features of secondary hyperhidrosis:
(1) often the sweating is generalized or involves a relatively large surface area
(2) sweating was normal previously as child, adolescent or young adult
(3) additional signs and symptoms ascribable to underlying condition
(4) sweating may occur at night (night sweats)
|
Cause |
Features |
Other |
|
chronic granulomatous inflammation (tuberculosis, brucellosis, etc.) |
fever, night sweats, lymphadenopathy |
remission after therapy |
|
menopause |
history of ovarian removal; middle aged woman with menstrual irregularities; hot flashes and other signs |
reduction with estrogenic replacement |
|
pheochromocytoma, carcinoid syndrome |
paroxysmal sweating, flushing |
responds to anticholinergics, remission after surgical resection, response to somatostatin analogue (octreotide) |
|
thyrotoxicosis |
tachycardia, elevated thyroid hormones |
beta-blockade; remits on control |
|
diabetes mellitus |
autonomic dysfunction |
|
|
acromegaly |
|
|
|
diencephalic epilepsy |
|
|
|
basilar artery occlusion with pontine ischemia |
abnormal vascular perfusion on angiography or vascular CT |
|
|
renal cell carcinoma, malignant lymphoma, leukemia |
night sweats, pruritus, lymphadenopathy |
remits on treatment of underlying disease |
|
chemical warfare agents (nerve gas, Sarin, Tabun) |
warfare, terrorism |
responds to anticholinergic agent, removal from exposure |
|
organophosphorus pesticides (malathion) |
farming, recent use or exposure to agents |
responds to anticholinergic agent, removal from exposure |
|
acetylcholinesterase inhibitors (physostigmine, neostigmine, edrophonium) |
recent drug administration |
stops after drug exposure discontinued |
|
nicotine poisoning |
excessive salivation and other signs of acute poisoning |
stops after drug exposure discontinued |
|
spinal cord injury |
orthostatic hypotension, autonomic dysreflexia, posttraumatic syringomyelia |
|
|
hypoglycemia |
low blood glucose, history of insulin administration, history of insulin producing carcinoid tumor |
responds to glucose administration, reduction in insulin |
|
anxiety |
panic disorder, stress |
responds to anxiolytics |
|
compensatory, following injury or surgery to sympathetic ganglia |
distribution of sweating, recent history of trauma or surgery |
|
|
peripheral neuropathy |
sensory and/or motor deficits |
|
where:
• Sudomotor nerve = stimulate sweat glands.
Purpose: To evaluate a patient with sweating over a relatively large area for a possible secondary cause.
Specialty: Dermatology
Objective: clinical diagnosis, including family history for genetics
ICD-10: R61,
