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Causes of Secondary Hyperhidrosis: Generalized hyperhidrosis
Generalized hyperhidrosis is usually secondary to an underlying
medical condition or can have a physiological basis with heat,
humidity, or exercise, leading to excessive sweating out of
proportion to thermoregulatory needs.[19]
Infections, neoplasia, metabolic and endocrine disorders,
high catecholamine states, drug therapy, and neurologic problems
can all be associated with systemic hyperhidrosis.[19,119]
Endocrine disorders associated with hyperhidrosis include
thyrotoxicosis, hyperpituitarism, diabetes mellitus, pheochromocytoma,
hypoglycemia, gout, and menopause.[19]
Although heat production increased by the higher metabolic
activity of the hyperthyroid state may lead to increased sweating,
a significantly increased perspiration rate was not seen in
thyrotoxicosis,[119]
nor was there an increased sensitivity of eccrine sweat glands
to stimuli known to increase secretion.[57]
Increased metabolic activity due to hyperpituitarism can lead
to increased thermoregulatory sweating.[57]
Excessive sweating, tachycardia, and headache in a patient
with hyperhidrosis should raise suspicion of pheochromocytoma
and prompt measurement of catecholamine levels.[119]
The “hot flashes” of menopause can be accompanied
by hyperhidrosis due to changing hormone levels.[57]
Acute and chronic infections and neoplasia can lead to fever
followed by excessive sweating.[134]
Often these conditions are associated with nocturnal diaphoresis,
or night sweats. Night sweats can be associated with tuberculosis,
endocarditis, other chronic infections, lymphoma, hyperthyroidism,
diabetes mellitus, hypoglycemia, systemic vasculitis, pheochromocytoma,
carcinoid syndrome, and drug withdrawal. Understanding of
the pathogenesis of night sweats associated with many of these
illnesses is incomplete, but they may be related to a decrease in
hypothalamic temperature setpoint.[119]
Conditions associated with high sympathetic discharge can
lead to excessive sweating. These would include respiratory
failure, cardiovascular shock and syncope, severe pain, and
alcohol or drug withdrawal.[19]
Drugs reported to cause hyperhidrosis include propanolol,
physostigmine, pilocarpine, tricyclic antidepressants, fluoxetine,
venlafaxine, and cyclobenzaprine.[19,119]
Familial dysautonomia, or Riley-Day syndrome, can lead to generalized
hyperhidrosis.[119]
A syndrome of episodic hypothermia with hyperhidrosis has
been described, due to episodic decreases in the hypothalamic
temperature setpoint as part of diencephalic epilepsy.[119]
Malformations such as agenesis of the corpus callosum, heterotopia,
porencephaly and brainstem nuclei abnormalities, and tumors or
surgical manipulation of the hypothalamus have all been implicated
in this syndrome.[119]
Hyperhidrosis has been seen without hyperthermia in patients
with a hypothalamic stroke.[119]
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