Pulmonary Carcinoma and Provocative Sweat Testing

Abstract

To the Editor.— In the article entitled Apical Pulmonary Adenocarcinoma With Contralateral Hyperhidrosis by McCoy and published in the October 1981Archives(117-659-661), McCoy failed to evaluate one important aspect of the sweat gland function of the skin ipsilateral to the tumor. A provocative sweat test would probably have shown hypohidrosis or even anhidrosis on the ipsilateral side. The test requires that the patient's legs be submerged in water at a temperature of 45 °C for 30 minutes to raise his core temperature; the starch iodide test normally shows sweating over the entire upper part of the body. 1 Photographs should be taken as soon as a good sweat response appears and before dripping and pooling of sweat confuse the pattern. A tumor invading the sympathetic nerves either irritates them, causing ipsilateral hyperhidrosis, 2 or destroys them, causing ipsilateral hypohidrosis. 3 In the case of ipsilateral hypohidrosis, reflex contralateral compensatory