Sweats

South Tees Hospitals NHS Foundation Trust

Definition/Description

We often referred patients with 'sweats' for investigation of possible haematological malignancy. Although it is true that haematological malignancy can cause drenching night sweats, it is unusual for this to be the sole presenting feature. Other systemic features may include unexplained weight loss (>10% body weight within 6 months), lymphadenopathy / splenomegaly or an abnormal full blood count.

Red Flag Symptoms

None provided

Guidelines on Management

Differential Diagnosis:

  • Obesity
  • Infection acute or chronic infections including tuberculosis, endocarditis and HIV infection.
  • Endocrine - menopause, hyperthyroid, diabetes mellitus, phaeochromo cytoma, carcinoid syndrome or acromegaly.
  • Neurological - Parkinsonism or autonomic neuropathy.
  • Malignancy - Haematological malignancy including myeloproliferative disorders or lymphoma.
  • Medication - in particular antidepressants (SSRIs, especially venlafaxine, and tricyclics), hormonal agents (e.g. tamoxifen, GnRH agonists) or NSAIDs.
  • Withdrawal from alcohol or illicit substances.

Examination:

  • Examine for lymphadenopathy, splenomegaly or hepatomegaly.

Baseline investigations:

  • Full blood count, blood film, basic biochemistry, LDH, immunoglobulins, TSH, glucose.
  • Other tests depending on suspected cause, e.g. chest x-ray, hormone levels, withdrawal of suspected medications.

Referral Criteria/Information

Referral:

  • NICE recommends considering a 2 week wait referral for patients having night sweats with unexplained splenomegaly or lymphadenopathy
  • Other speciality referrals depending on suspected cause.

Additional Resources & Reference

References:

Paisley AN, Buckler HM. Investigating secondary hyperhidrosis. Br Med J 2010; 341: 4475.

NICE. Suspected cancer: recognition and referral. June 2015, update Oct 2023

NICE Clinical Knowledge Summary. Haematological Cancers - Recognition and Referral (February 2021). https://cks.nice.org.uk/haematological-cancers-recognition-and-referral 

NICE Clinical Knowledge Summary. Hyperhidrosis (September 2023). https://cks.nice.org.uk/topics/hyperhidrosis/ 

Associated Policies

There are no associated policies.

Specialties

Haematology North Yorkshire

Places covered by

  • North Yorkshire

Hospital Trusts

  • South Tees Hospitals