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)




chronic granulomatous inflammation (tuberculosis, brucellosis, etc.)

fever, night sweats, lymphadenopathy

remission after therapy


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)


tachycardia, elevated thyroid hormones

beta-blockade; remits on control

diabetes mellitus

autonomic dysfunction





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



low blood glucose, history of insulin administration, history of insulin producing carcinoid tumor

responds to glucose administration, reduction in insulin


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




• Sudomotor nerve = stimulate sweat glands.


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