Intended for healthcare professionals

Practice Rational Testing

Investigating secondary hyperhidrosis

BMJ 2010; 341 doi: (Published 09 September 2010) Cite this as: BMJ 2010;341:c4475
  1. A N Paisley, specialist registrar,
  2. H M Buckler, consultant
  1. 1Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford M6 8HD
  1. Correspondence to: H M Buckler helen.buckler{at}

    Excessive sweating can be due to menopause or drugs but can also result from neoplastic and neurological disease and endocrine or metabolic disorders

    Learning points

    • Hyperhidrosis can result from underlying medical conditions, menopause, or drugs

    • Clinicians should not immediately conclude that sweating in a woman of menopausal age is due to menopausal hot flushes

    • Patients can present with menopausal symptoms some time after they have completed the menopause

    • Initial investigations should include gonadotrophin and oestradiol concentrations to confirm menopausal status, thyroid function tests looking for evidence of hyperthyroidism, and full blood count to help exclude an underlying haematological disorder

    A 52 year old woman presented to her general practitioner with a three month history of excessive and distressing chest and facial sweating. This occurred both day and night (often requiring changes of the bed clothes), and at times was associated with facial flushing. She was otherwise well, her weight was stable, and there was no important medical history. Her menstrual cycle had been regular until three years previously but since then had become more erratic, and she had not had a period for 12 months.

    What is the next investigation?

    Hyperhidrosis (excessive sweating) affects 2.8% of the population.1 Secondary hyperhidrosis tends to present in adulthood and occurs both during waking and sleeping, unlike primary (idiopathic, essential) hyperhidrosis. Although hyperhidrosis can be due to menopause or drugs, it can also result from underlying medical conditions. The …

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