Autonomic dysfunction in palmar hyperhidrosis

Abstract

The autonomic (including sudomotor, baroreceptor, and vasomotor) functions were assessed in 3 groups of individuals, comprising normal, hyperhidrotic, and denervated subjects. The normal group had no palmar hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3 ganglia, and the denervated group had palmar hyperhidrosis treated with T2-3 ganglionectomy. Compared with both the normal and hyperhidrotic subjects, the denervated subjects had a much smaller sweating response of both the forehead, the upper chest region and the upper extremities, and a much greater sweating response of both the lateral lumbar and ventral thigh regions in response to body exercise. In addition, cardiovascular responses to either the Valsalva manoeuver, face immersion, or finger immersion were evaluated in these groups of subjects. When compared with those of either the normal or the denervated subjects, the hyperhidrotic subjects had less reflex bradycardia in response to either Valsalva manoeuver or face immersion. In contrast, when compared with those of either the normal or the denervated subjects, the hyperhidrotic subjects had a higher degree of cutaneous vasoconstriction in response to finger (or cold) immersion. The data indicate that the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere. Probably, the hyperhidrotic subjects have an over-functioning of the sympathetic nervous fibers which pass through the T2-3 ganglia, which leads to autonomic dysfunction. The autonomic dysfunctions observed in the hyperhidrotic subjects could be eliminated after the interruption of the excessive sympathetic activities passing through the T2-3 ganglia level. A preliminary report of this work was delivered at the 15th Congress of the Pan-Pacific Surgical Association, January 12–18, 1980 and the 12th World Congress of Neurology, September 20–25, 1981.