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Forum Name: Hematology Topics

Question: High Haemoglobin and Night Sweats


 Ssusan - Sun Aug 15, 2010 6:08 am

Hi

I have been getting night sweats for some time. I would sleep for 3 hours and wake up feeling hot. Once I am awake, then I my heart starts to palpitate. I then start to sweat. It take me a little while to cool down before I can go back to sleep. This happens again after sleeping for another 3 hours or so.

I wake up in the morning feeling dopey (even after having slept for 10 hours). I have lost my appetite and at times feel nasueas.

I have been to the doctors and they have done a lot of test. My thyriod is fine and no lung infection. However, lately, they noticed I have a high haemoglobin (162g/l)and RBC Count reading (5.31).

Also, i have noticed my tongue is very white in colour.

Can you help

regards
 Dr.M.jagesh kamath - Fri Aug 20, 2010 12:07 pm

User avatar Hello,Nocturnal sweating is a common condition associated with certain conditions like tuberculosis,immune deficiencies,nocturnal hypoglycemias of diabetes,sleep apnea,and last but not the least, hyperthyroid states.Also labile hypertension, diarrhea,palpitations are features of pheochromocytomas which are tumours of the adrenals which again can present with night sweats. Diagnosis is by testing for urinary 5-HIAA.Polycythemia can also lead to excessive sweating,itching,and giddiness associated with high Hb and high concentration of red blood cells.Average age of diagnosis is around 60 years for polycythemias.Itching after bath occurs as a specific feature in some patients with polycythemia vera.
While I have narrated some clinical conditions relating to sweating in your case may be related to your hyperthyroid state.May be you may need to get another review of your thyroid status.Do consult your physician.
Best wishes.
 Dr.M.Aroon kamath - Sat Aug 21, 2010 1:18 am

User avatar Hi,
Hi,
From a surgical perspective, i note that you have not mentioned the cause of hyperthyroidism in your case. Was it Graves' disease or a toxic adenoma or something else.The reason why it is important is that Graves' diseae, is usually associated with anemia, rather than erythrocytosis or polycythemia. Erythroid bone marrow hyperplasia is commonly seen and usually they develop features of an iron deficiency anemia as this condition often affects menstuating women.

One condition that can cause nocturnal sweating is hypoglycemia. This may be,
- chronic idiopathic hypoglycemia,
- hypoglycemia associated with insulin therapy in diabetics, or
- caused by insulinomas.

Insulinomas may be
- sporadic or
- occur in association with multiple endocrine neoplasia (MEN 1).


Insulinomas generally need the presence of the 'Whipple triad' and laboratory evidence of hyperinsulinemic hypoglycemia for the diagnosis. But atypical cases do occur, and can be very difficult to diagnose.Sometimes, the hypoglycemia can be purely nocturnal and in such cases, the affected individuals may only recall sweating among the neuroglycopenic symptoms.

The components of MEN 1 syndrome are as follows,
- pitutary tumors,
- Hyperparathyroidism (the most common),
- Pancreatic islet cell tumors(the second most common),
- insulinomas (20-35% of functional pancreatic islet cell tumors),
- gastrinomas,
- glucagonomas,
- carcinoid tumors,and
- Thyroid adenomas (5-30% of patients).
As Dr.Jagesh has suggested, your thyroid function needs to be re-assessed first. If you are euthyroid, then other causes need to be excluded.
Best wishes!

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