Night Sweats Differential Diagnosis

A differential diagnosis is made through a process of elimination. Depending on which symptoms fit and which don't, some conditions can be ruled out, while others come closer to the cause of the problem. Night sweats, or nocturnal diaphoresis, is a symptom that could indicate any one, or more than one, possible conditions and disorders. The skin is an organ of elimination, and there are several possible reasons it might attempt to compensate for other body processes.

Physiological Variants

• Night sweats could be caused by too warm an environment, or too many covers while sleeping. Fever can cause night sweats. Heavy alcohol use is a possible reason for night sweats. Pregnancy or menopause are two conditions in which night sweats occur. Of course, if the patient is not female, or is too young or too old to be affected by those conditions, they can be ruled out.

Metabolic/Biochemical Disorders

• Night sweats are symptoms commonly associated with diseases of sugar storage and regulation, such as hypoglycemia and diabetes. Patients who are morbidly obese may also have night sweats. Medications such as insulin can induce night sweats. Kidney and digestive diseases should also be ruled out. Hyperthyroid, an imbalance of the endocrine system, may also be responsible for night sweats.
  Medications used to lower blood pressure can cause excessive sweating at night.

Infectious Diseases

• Night sweats are symptomatic of lyme disease, tuberculosis, malaria and HIV infection. Physicians should ask about fever, cough, sore throat and risk factors that might indicate exposure. Infected organs, such as liver, kidneys, endocarditis (lining around the heart) and lung infections may also cause night sweats. Of course, people with these conditions could be expected to be in obvious pain and distress.

Cancers/Structural Abnormalities

• Night sweats might be a warning sign of cancers such as leukemia, Hodgkins disease, lymphoma and renal malignancy. Weight loss might be another indicator.
  Diverticulitis, bowel obstruction, Crohn's disease and colitis that block or distort the intestines may trigger night sweats. Those with autoimmune disorders such as fibromyalgia and chronic fatigue syndrome experience night sweats.

Poisons

• Medication toxicity, especially some antidepressant drugs, can account for night sweats.

  Alcohol intoxication or binging commonly brings on night sweats. Heroin detoxification is another possible cause.

  Night sweats could indicate heavy metal (mercury) toxicity in adults or children.

  A careful history and physical, as well as the results of lab tests and imaging, are most likely to determine the cause or causes of night sweats.