Clinical Question: How to Approach a Patient Presenting With Sweating and Flushing

Sweating and flushing are normal physiological processes, but may be the presenting feature of endocrine disease and are a frequent reason for referral from primary care. The most common endocrinopathies causing sweating include excursions of blood glucose, hypogonadism and thyroid dysfunction. Rarer pathologies include phaeochromocytoma or paraganglioma (PPGL), neuroendocrine tumours (NETs), and medullary thyroid carcinoma, which present with a constellation of symptoms that require a clinical index of suspicion. The pre-test probability of sweating being caused by rare endocrinopathies is significantly increased in the context of a family history of known tumour-predisposing germline mutations. Primary hyperhidrosis may have a hypothalamic basis and should be referred for consideration of neurological disease. Where no endocrine pathology is found, managing patient expectations, considering potential causes such as medication and non-endocrine diseases, and involving other clinicians with a pragmatic approach to symptom improvement are important aspects of the consultation in patients with sweating and flushing.