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Hyperhidrosis and the sympatho-adrenal system.

D Robertshaw

    Medical Hypotheses
    |March 1, 1979
    PubMed
    Summary

    Excessive sweating (hyperhidrosis) in certain disorders is linked to increased sympatho-adrenal activity. Cholinergic pathways primarily drive this sweating, not adrenergic stimulation, suggesting targeted treatments.

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    Area of Science:

    • Physiology
    • Endocrinology
    • Dermatology

    Background:

    • Hyperhidrosis, or excessive sweating, is a symptom in disorders with increased sympatho-adrenal activity, including hypotension, hypoglycemia, pheochromocytoma, and hyperthyroidism.
    • Sweat glands are primarily controlled by cholinergic innervation but can be influenced by adrenergic agents.
    • Adrenergic innervation of sweat glands has been identified, with a role in exercise-induced sweating.

    Purpose of the Study:

    • To investigate the mechanisms underlying hyperhidrosis in specific sympatho-adrenal disorders.
    • To differentiate the roles of cholinergic and adrenergic systems in pathological sweating.
    • To explore the contribution of catecholamines and thermogenesis to excessive sweating.

    Main Methods:

    • Review of existing literature on sweat gland innervation and control.
    • Analysis of the physiological responses in disorders associated with hyperhidrosis.
    • Pharmacological considerations of alpha- and beta-receptor blockade on sweating.

    Main Results:

    • Sweating in the studied disorders is primarily mediated by cholinergic pathways, not adrenergic stimulation.
    • Adrenergic stimulation is implicated in exercise-induced sweating but not pathological hyperhidrosis.
    • Elevated plasma catecholamines can cause cutaneous vasoconstriction, reducing sweat evaporation and increasing sweat accumulation.
    • Hyperhidrosis in pheochromocytoma may involve central heat loss activation and increased thermogenesis.
    • Hyperthyroidism-associated hyperhidrosis is likely due to increased thermogenesis.

    Conclusions:

    • The hyperhidrosis observed in hypotension and insulin hypoglycemia stems from general sympathetic stimulation, independent of adrenal medullary hormones.
    • Cholinergic blocking agents effectively manage hyperhidrosis in these conditions.
    • Understanding the distinct roles of cholinergic and adrenergic systems is crucial for managing hyperhidrosis in various endocrine and circulatory disorders.

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