| Etiology | Suggestive features on history | Suggestive physical examination findings or results of confirmatory testing |
| Malignancy | - History of malignancy
- Unintentional weight loss, fevers, fatigue, or pruritus (lymphoma)
- Development of enlarged lymph nodes
| - Lymphadenopathy
- Abnormal blood tests (tests selected based upon suspected condition)
- Abnormal imaging
|
| Infection |
| | - Symptoms of active TB, such as cough, sputum, fatigue, and unintentional weight loss
- Risk factors for TB including a prior positive TB skin test or IGRA, HIV infection, hemodialysis, gastrectomy, solid organ transplantation, exposure to an individual with TB, being homeless or living in an institutionalized setting, immigration from an endemic area, or working in a health care setting
| - Abnormal pulmonary examination
- Imaging consistent with active TB
- Positive AFB smear and/or culture of sputum or other body fluid
|
| | - Localized pain, especially back or joint pain, which (particularly if accompanied by fever) might suggest endocarditis, abscess, osteomyelitis, or spinal infection
- Risk factors for endocarditis (eg, chronic indwelling vascular catheter, injection drug use, prior history of endocarditis, recent dental work, risk factors for endocarditis, immunosuppression)
| - Clinical evidence of infection (eg, point vertebral tenderness, clinically infected joint, new regurgitant cardiac murmur, evidence of emboli)
- Positive blood cultures
- Cardiac valvular vegetations seen on echocardiogram
- Other imaging demonstrating locus of infection
|
| | - Thrush, diarrhea, unintentional weight loss, or report of enlarged lymph nodes
- Risk factors for HIV infection such as injection drug use, men who have sex with men, sexual activity with multiple partners, or commercial sex work
| |
- Geographic infection risk
| - Residence in or any recent travel to areas where certain infections such as malaria, typhoid fever, or tick-borne diseases are endemic
- Any known or suspected mosquito or tick bites; food and water hygiene; use of chemoprophylaxis for malaria (if indicated), and country-specific vaccination status
| - Appropriate laboratory testing for suspected infections*
|
| Endocrine causes |
- Alteration in estrogen or androgen levels
| - For females, consider age and menopausal (surgical, drug induced, or natural) status; also inquire about the use of estrogen-containing products and recent obstetric history
- For males, any history of androgen deprivation therapy (chemical or surgical) and the temporal relationship to the onset of sweats
| - We do not immediately conclude that sweating episodes in women of typical perimenopausal age represent hot flashes unless characteristic features are present;¶ if there are concerning associated symptoms (eg, weight loss, pruritis) or localizing symptoms, we pursue further diagnostic studies as appropriate
|
| | - Weight loss, tremors, heat intolerance, and diarrhea
| - Thyromegaly, brisk DTRs, exophthalmos
- Abnormal thyroid function testsΔ
|
| | - Episodic headache, sweating, and tachycardia
| - Sustained or intermittent hypertension
- Elevated blood and/or urinary catecholamines and metanephrines◊
|
| | - Flushing, with diarrhea and/or wheezing
| - Elevated serum or urinary 5-HIAA§
|
| | - Unexplained weight gain, hypoglycemic episodes
| - Hypoglycemia accompanying sweating episodes
- Elevated C-peptide¥
|
| | - Acral and soft tissue overgrowth, headaches, skin thickening, macrognathia, macroglossia
| |
| Medications | - Temporal relationship between the development of symptoms and starting a medication known to cause sweating
| - Trial of discontinuing the likely causative medication (if possible) with substitution of another medication, or dose reduction if discontinuation not possible
|
| Neurologic causes |
| | - History of spinal cord injury or other abnormality (eg, syringomyelia)
| |
