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1 Assistant Professor Ferris State University Sparrow Family Medicine Clinic 1200 East Michigan Avenue, Suite 245 Lansing, Michigan 48912-2109 fax 517/364-5740 edickc{at}ferris.edu
Published Online, September 13, 2005. www.theannals.com, DOI 10.1345/aph.1G136
Case Report. In March 2004, a 60-year-old white woman presented to the clinic with profuse diaphoresis following food consumption. The sweating started 8 weeks prior to the visit and had become very uncomfortable. Immediately after eating, she experienced profuse sweating of her face, neck, and scalp that was socially and professionally problematic. Past medical history included pancreatitis, type 2 diabetes mellitus for 12 years, peripheral neuropathy, microalbuminuria, hyperlipidemia, labile hypertension, silent myocardial ischemia, severe cerebral concussion, peripheral vascular disease, tumor in the second cranial nerve, and osteoarthritis. Blood pressure ranged between 100/60 and 130/64 mm Hg, with an average pulse rate of 76 beats/min. Early morning blood glucose values ranged between 75 and 80 mg/dL, ruling out hypoglycemia as the potential cause. Preprandial blood glucose values ranged between 80 and 120 mg/dL with insulin and metformin. The woman was also attempting smoking cessation using buproprion sustained release and had decreased to 10 cigarettes daily. The patient reported she felt "hormonal," yet thyroid-stimulating hormone, follicle-stimulating hormone, and sedimentation rates were within normal limits. No diagnosis was made at this time.
The woman returned to the clinic one month later, still experiencing profuse sweating of her scalp, head, and neck immediately after food consumption. The diaphoresis was not associated with any particular type of food, but occurred as soon as she began eating. She admitted to allowing her fasting blood glucose levels to range between 76 and 179 mg/dL in the hope of alleviating any possible hypoglycemia, but this did not help her condition.
The patient was diagnosed with diabetic gustatory sweating. She started on glycopyrrolate 1 mg twice daily instead of topical glycopyrrolate due to scalp involvement. She felt relief immediately, and the discomfort surrounding meal consumption was alleviated. She did not experience symptoms of orthostatic hypotension or constipation with oral glycopyrrolate; however, she did complain of increased mouth dryness. Glycopyrrolate was decreased to either one-half tablet at night or one-half tablet twice daily to alleviate this symptom.
A phone follow-up nearly one year later confirmed the successful resolution of profuse diaphoresis. She has decreased her glycopyrrolate dosage to 1 mg once daily taken in the late morning. She still experiences occasional diaphoresis, but is otherwise controlled. Other current medications include lisinopril, fenofibrate, cilostazol, calcium, metformin, metoprolol extended release, pantoprazole, and insulin 70/30 units.
Discussion. Treatment options for gustatory sweating include oral
anticholinergics, centrally acting 
2-agonists, or
topical
glycopyrrolate.1,3
Oral anticholinergic use is limited by adverse effects, while the use of
topical glycopyrrolate is impractical, as it can be quite costly to patients
and difficult to find a pharmacy to compound
it.1,2,4,5
The patient discussed here tolerated low-dose oral glycopyrrolate without
problematic adverse effects. Although more long-term data are needed, the use
of glycopyrrolate for diabetic gustatory sweating may be a viable option.
References
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