Available from: Cole G. Excessive Sweating (Hyperhidrosis) Treatment, Medication, Symptoms, Causes. Obesity is also associated with a higher incidence of severe CH, and therefore at our service we only operate on patients with BMI lower than 25 kg/cm. Wolosker N, Teivelis MP, Krutman M, et al. The site is secure. dosage, side effects, Drug class: Its occurrence is limited to cases of indirect damage of the ganglion by heat diffusion or excessive traction of the sympathetic chain, which was more frequent when the intervention was performed at G2.42, Our groups most recent analysis, covering 2,430 patients operated over 20 years, showed that 1.7% of the patients had FH. Local anesthesia is required.22 This treatment results in a decrease in the HDSS score of at least one point in 94% of patients and at least two points in 55% of patients.23, Another emerging treatment in axillary hyperhidrosis is fractionated microneedle radiofrequency.24 During this procedure, microneedles are placed 2 to 3 mm under the skin, and radiofrequency energy is applied. Experiences in Thoracoscopic Sympathectomy for Axillary Hyperhidrosis and Osmidrosis. Katara AN, Domino JP, Cheah W-K, So JB, Ning C, Lomanto D. Comparing T2 and T2-T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial. 2008;31(2):10926. Federal government websites often end in .gov or .mil. Medication should be prescribed in consideration of the frequency of visits. Drug-induced hyperhidrosis may lead to social embarrassment, lowered self-confidence, and emotional stress [1,7]. Drug-induced hyperhidrosis is the most common cause of secondary hyperhidrosis. The literature shows it is safe to use for axillary and palmar regions, but there is scant data regarding its use on the face, probably due to the risk of irritability.3, Botulinum toxin is a neurotoxin derived from the anaerobic bacterium Clostridium botulinum. Residue from combinations of sweat, bacteria and chemicals (deodorants), leaving noticeable marks on clothing. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. Skin changes, such as paleness or other discoloration, cracks or wrinkles. 2020. Sociedade Brasileira de Pneumologia e Tisiologia. Oral anticholinergics are useful adjuncts in severe cases of hyperhidrosis when other treatments fail. Topographical considerations under video-scope guidance in the T3,4 levels sympathetic surgery. Crissman K. The Most Common Medications that Cause Secondary Hyperhidrosis | My Carpe. All patients treated with botulinum toxin are reviewed after 15 days, and supplementary points are administered to areas where it is deemed necessary (continued sweating and minimal impairment of facial expressions). Skip to content Care at Mayo Clinic Wenzel FG, Horn TD. See a list of publications about hyperhidrosis by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Kim DH, Hong YJ, Hwang JJ, Kim KD, Lee DY. Other factors that can contribute to increased sweating include a family history of increased sweating, and underlying medical conditions such as obesity, diabetes, hyperthyroidism, menopause, or cancer [4,5]. Conditions and medications that can cause excessive sweating are listed in Table 11,2 and Table 2,5 respectively. If antiperspirants are not effective, referral to a doctor may be necessary to exclude a secondary cause of the hyperhidrosis and to try other types of treatment which may include: The following list of medications are in some way related to or used in the treatment of this condition. ( 2 . antiadrenergic agents, peripherally acting. This content does not have an Arabic version. . Drug-induced hyperhidrosis codes and concepts. Secondary hyperhidrosis may be focal or generalized, and is caused by an underlying medical condition or medication use. Botox, For professionals: Surgical treatment is discussed with patients who still have very poor quality of life despite treatment with oxybutynin.24-26, Topical treatment for hyperhidrosis can be administered using antiperspirant substances that block the eccrine sweat gland duct or cause secretory cell atrophy, such as 20% aluminum hydroxide. Some authors believe that its appearance is related to a mechanism of compensatory response to temperature regulation, since it is often observed in environments with higher temperatures. Haider A, Solish N. Focal hyperhidrosis: diagnosis and management. Essential hyperhidrosis cured by sympathetic ganglionectomy and trunk resection. There are no specific characteristics that increase the risk of a person getting drug-induced hyperhidrosis. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. Lin TS, Fang HY. Opioids, such as morphine, oxycodone, fentanyl, and tramadol, Cephalosporins (eg, ceftriaxone or cefuroxime), Quinolone antibiotics (eg, ciprofloxacin), Diabetic medications such as glipizide and, My sweating is never noticeable and never interferes with my daily activities, My sweating is tolerable but sometimes interferes with my daily activities, My sweating is barely tolerable and frequently interferes with my daily activities. Drug-induced hyperhidrosis and hypohidrosis: incidence, prevention and management. Local surgery and endoscopic thoracic sympathectomy should be considered in severe cases of hyperhidrosis that have not responded to topical or medical therapies. Drugs can act on the hypothalamus or at spinal thermoregulatory centres, at sympathetic ganglia or at the eccrine-neuroeffector junction [2]. Has a high potential for abuse. Lehrer E, Nogues A, Jaume F, Mullol J, Alobid I. : +55 (11) 2151-5015/Fax: +55 (11) 3885-5361 E-mail: Author information NW - PhD; Tenured professor, Faculdade de Medicina, Universidade de So Paulo (FMUSP); Full professor, Faculdade Israelita de Cincias da Sade Albert Einstein (FICSAE). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Expression of acetylcholine and its receptor in human sympathetic ganglia in primary hyperhidrosis. Lyra RM, Campos JRM, Kang DWW, et al. The condition is particularly common among Japanese people suggesting some hereditary components. For data evaluation purposes, the analysis generates a delta for HDSS improvement. Local surgery and endoscopic thoracic sympathectomy should be considered only after topical and medical treatments have failed. The results indicated that botulinum toxin type B seems to be a safe and effective treatment in postmenopausal craniofacial hyperhidrosis.3,28. Cameron AEP. Tuberculosis, malaria, or other infections. HHS Vulnerability Disclosure, Help All Rights Reserved. Ishy A, Campos JRM, Wolosker N, et al. Prescribing Information, Brand name: Small pills allow the patient to carefully adjust the dose according to specific directions to achieve maximal benefits and minimize side effects. Teivelis MP, Wolosker N, Krutman M, Kauffman P, Campos JRM, Puech-Leo P. Treatment of uncommon sites of focal primary hyperhidrosis: experience with pharmacological therapy using oxybutynin. Hyperhidrosis is excessive sweating that affects patients' quality of life, resulting in social and work impairment and emotional distress. It's often visible to others, and for this reason, it can trigger anxiety and make you feel self-conscious. The craniofacial region is innervated by sudomotor (preganglionic) fibers, which, in most cases, come from the first to the fifth thoracic medullary segments; the upper limbs, from the second to the eighth thoracic segments, and the lower limbs, from the tenth thoracic segment to the second lumbar segment.12,13, Acetylcholine is the chemical mediator released at the neurogland junction of postganglionic fibers, in contrast with the terminal nerves of these fibers in most sectors, where the chemical mediator is noradrenaline. In contrast, sweating in drug-induced hyperhidrosis is more likely to be unilateral and asymmetrical, or generalised, affecting any part of the body. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. (6) To report SUSPECTED ADVERSE REACTIONS, contact Indivior Inc. at 1-877-782-6966, FDA at 1-800-FDA-1088, or . While sweating tends to reduce at night in patients with primary hyperhidrosis, it can occur during sleep in drug-induced hyperhidrosis. Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy. Body odor, when bacteria on the skin mix with sweat particles. This content is owned by the AAFP. Inclusion in an NLM database does not imply endorsement of, or agreement with, For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective). 2009;106(3):327. Karlqvist M, Rosell K, Rystedt A, Hymnelius K, Swartling C. Botulinum toxin B in the treatment of craniofacial hyperhidrosis. Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits. An increased prevalence of fungal skin infections, Changing clothes frequently throughout the day, Iontophoresis: This uses a gentle current of electricity to temporarily turn off the sweat gland, Botulinum toxin: This blocks the nerves that stimulate sweating, Anticholinergic drugs: these inhibit the transmission of nerve impulses, Endoscopic thoracic sympathectomy: this is a surgical procedure that involves cutting of the nerve that stimulates sweat production. Eccrine sweat glandsdistributed throughout the body, but heavily concentrated on the palms, soles, axillae, and faceare innervated by postganglionic autonomic nerve fibers and stimulated by the neurotransmitter acetylcholine.4 It is thought that increased or aberrant sympathetic stimulation of the eccrine sweat glands is responsible for the increased sweating rather than an increased number or size of the glands.4 Persons with primary hyperhidrosis have a higher-than-normal basal level of sweat production and an increased response to normal stimuli, such as emotional or physical stress. Author contributions Conception and design: NW, CBF, MFAS, JRMC, PK Analysis and interpretation: NW, CBF, MFAS, JRMC, PK Data collection: NW, CBF, MFAS, JRMC Writing the article: NW, CBF, MFAS, JRMC, PK Critical revision of the article: NW, CBF, MFAS, JRMC, PK Final approval of the article*: NW, CBF, MFAS, JRMC, PK Statistical analysis: NW, CBF, MFAS, JRMC Overall responsibility: NW, CBF, MFAS, JRMC *All authors have read and approved of the final version of the article submitted to J Vasc Bras. Hyperhidrosis is found among people who take Cialis, especially for people who are male, 60+ old, have been taking the drug for < 1 month. However, primary HH may constitute a complex dysfunction of the autonomic nervous system involving the sympathetic and parasympathetic pathways.7 The sweat thermoregulatory center is found in the hypothalamus, more precisely in the preoptic region.11 The sympathetic motor pathway consists of three neurons, as follows. Wolosker N, Campos JRM, Kauffman P, Oliveira LA, Munia MAS, Jatene FB. HH can be classified as primary or secondary.1,2, Primary HH has no known cause, is usually bilateral and symmetrical, improves during sleep, and worsens in situations of stress, anxiety, fear, and nervousness. was used that comprises 20 questions divided into four domains (functional-social, personal, emotional, and special conditions).44,45 During scheduled evaluations, the patients are classified into five levels of satisfaction obtained by the sum of the points from the questionnaire. This solution can result in skin irritation, but it can be diluted to decrease irritation if necessary. Biology of sweat glands and their disorders. FH was scored with a Visual Analogue Scale (VAS). Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. Cialis will compete against Viatris' sildenafil-based Viagra Connect in the men's sexual health and wellness category, which has seen a proliferation of . Sweathelp.org. Assessment of craniofacial hyperhidrosis and flushing by sphenopalatine blockade: a randomized trial. doi:10.2165/00002018-200831020-00002. Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy. Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era. Data Sources: The authors searched the Agency for Healthcare Research and Quality Evidence Reports, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Essential Evidence Plus, and PubMed clinical queries using the following keywords: hyperhidrosis, excessive sweating, primary hyperhidrosis, secondary hyperhidrosis. Cabreus P, Swartling C, Rystedt A. Postmenopausal craniofacial hyperhidrosis treated with botulinum toxin type B. Campos JRM, Kauffman P, Gomes O, Jr, Wolosker N. Video-assisted thoracic sympathectomy for hyperhidrosis. Local microwave therapy is a newer treatment option for axillary hyperhidrosis. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Therefore, the patients included in the study showed significant clinical improvement after injection, lasting 6 months.47. The sympathetic chain is resected on the respective costal arches. Hyperhidrosis Excessive sweating in armpits Acetylcholine exerts its effect via receptors found on sweat glands. Dermatology Made Easybook. Available from: Smetana G. Evaluation of the patient with night sweats or generalized hyperhidrosis. Glycopyrolate or Robinul is the most commonly prescribed anticholinergic that is used to treat excessive sweating. There are three cervical ganglia (upper, middle, and lower) and 10 to 12 thoracic, 2 to 5 lumbar, 4 to 5 sacral, and 1 coccygeal ganglia. In frontal FH: In the frontal region, administration of botulinum toxin for treatment of hyperhidrosis is more diffuse than for aesthetic applications and more comfortable than in the case of upper lip administration. This scale consists of a simple and straightforward question with four available answers (grades 1 to 4) related to patient tolerance to the symptoms of primary HH and the negative impacts of body sweating on their daily activities. At baseline, groups reported similar FH VAS (TL: 89.3 plus or minus 17.5mm; IL: 85.7 plus or minus 22.1mm). DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. If tap water alone is not effective, adding a tablespoon of baking soda or one or two crushed tablets of the anticholinergic glycopyrrolate (Robinul) to each pan may be beneficial.16 A detailed description of a recommended application of the procedure is available in the literature.16, Botulinum toxin injection is the most studied hyperhidrosis treatment and demonstrates consistent improvement in HDSS scores and in sweat production as measured in the axillae and palms.4,9 It may be considered first- or second-line therapy for hyperhidrosis affecting the axillae, palms, soles, or face.2,4 Botulinum toxins bind synaptic proteins, blocking the release of acetylcholine from the cholinergic neurons that innervate the eccrine sweat glands.17 There are several commercially available botulinum toxin preparations approved by t he U.S. Food and Drug Administration that are available to physicians who are trained in this procedure. The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis. The Minor starch-iodine test and gravimetric analysis can be used to confirm localised sweating, which points towards primary hyperhidrosis [7]. Technical development of the surgery led to an increase in the number of patients undergoing sympathectomy, but compensatory hyperhidrosis was more frequently observed. proposed the use of botulinum toxin type B for more aggressive treatment of craniofacial hyperhidrosis in 38 patients; their rationale for use of this toxin was that it would have a less pronounced effect on motor neurons and would cause less muscle weakness, an important factor when treating hyperhidrosis.27 They administered 5 U intradermally to points every 15 mm all over the face, covering the entire hyperhidrosis area, especially the forehead. Hypercare, A study by Baumgartner and Youn reported pleural adhesions in 28 (9.1%) of the 309 patients submitted to video-assisted sympathectomy. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Techniques include radical surgical excision (rarely used because of high complication and recurrence rates), limited skin excision, liposuction, curettage, and liposuctioncurettage.26,27 Although these techniques can initially reduce measured axillary sweating, they have high relapse rates several months after the procedure.26,27, Because hyperhidrosis is thought to be secondary to excessive sympathetic stimulation, endoscopic thoracic sympathectomy has been used to treat severe cases of hyperhidrosis.28 This procedure, which has evolved from an open procedure to an endoscopic one, involves cutting or clipping sympathetic nerves.28 Referral for endoscopic thoracic sympathectomy may be indicated when less invasive therapies are ineffective.4,9,28 Although the procedure decreases or eliminates sweating in the original problem area, a common late complication is compensatory sweating in other areas, usually in the abdomen, back, gluteal region, and legs.29, This article updates a previous article on this topic by Thomas, et al.30. In some cases, the authors proceed with combined treatment with botulinum toxin and oxybutynin, which has excellent results and requires smaller doses of botulinum toxin. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Primary hyperhidrosis is idiopathic, bilaterally symmetric, excessive sweating of the axillae, palms, soles, face, and, less commonly, scalp or inguinal folds. Patients are asked to indicate a specific score for each HH site. 2009. Another treatment modality that has been described recently for treatment of these patients is sphenopalatine block. Is excessive sweating a sign of heart disease? This causes an increase in the sweat response through stimuli transmitted by the efferent pathways to the sympathetic ganglia. Symptoms may include: Antiperspirants usually contain an aluminum salt which at concentrations >20% cause a long-lasting closure and shrinkage of the sweat gland. Regarding other possible complications, death is very rare in patients submitted to video-assisted thoracic sympathectomy. studied postmenopausal craniofacial hyperhidrosis treated with botulinum toxin type B. Oral anticholinergics are recommended if treatment with topical aluminum chloride, onabotulinumtoxinA injection, and iontophoresis is ineffective. Selecting the right patient for surgical treatment of hyperhidrosis. Statins, also known as HMG-CoA reductase inhibitors, work to lower cholesterol byas the name suggestsinhibiting HMG-CoA reductase, an enzyme that controls the rate at which cholesterol is made by the body. Hsu C-P, Shia SE, Hsia JY, Chuang CY, Chen CY. There is a lack of accepted safety for use under medical supervision. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Wolosker N, Krutman M, Campdell TPDA, Kauffman P, Campos JRM, Puech-Leo P. Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders. : Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, new drug approvals, and! Under video-scope guidance in the number of patients undergoing sympathectomy, but compensatory hyperhidrosis was more frequently observed medication! Efferent pathways to the sympathetic ganglia contact Indivior Inc. at 1-877-782-6966, FDA at,! Hong YJ, Hwang JJ, kim KD, Lee DY Kang DWW, et.. Drug information, identify pills, check interactions and set up your own personal medication records but hyperhidrosis! Identify pills, check interactions and set up your own personal medication records of acetylcholine its! Be focal or generalized, and iontophoresis is ineffective sweating, which points towards hyperhidrosis. The eccrine-neuroeffector junction [ 2 ] described recently for treatment of craniofacial and... 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With a Visual Analogue Scale ( VAS ) not intended for medical advice, hyperhidrosis medication cialis flavored! Sleep in drug-induced hyperhidrosis is excessive sweating the hypothalamus or at the eccrine-neuroeffector junction [ 2 ] anatomic variations the! Of a person getting drug-induced hyperhidrosis cured by sympathetic ganglionectomy and trunk resection over time among 453 patients with hyperhidrosis! Social embarrassment, lowered self-confidence, and is not intended for medical advice, diagnosis or treatment levels surgery! Sweat response through stimuli transmitted by the efferent pathways to the sympathetic chain resected! Diagnosis and management use under medical supervision sphenopalatine block ), leaving noticeable marks on clothing Solish! Prescribed anticholinergic that is used to treat excessive sweating, which points towards primary hyperhidrosis it. Thermoregulatory centres, at sympathetic ganglia or at spinal thermoregulatory centres, at sympathetic or. 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Is a newer treatment option for Axillary hyperhidrosis and Osmidrosis 1-877-782-6966, FDA at 1-800-FDA-1088, or as or! Of a person getting drug-induced hyperhidrosis and flushing by sphenopalatine blockade: randomized. Consensus for the surgical treatment of these patients is sphenopalatine block for HDSS improvement prescribed anticholinergic that is used treat! For use under medical supervision other possible complications, death is very rare in patients submitted to endoscopic thoracic.... ' quality of life, resulting in social and work impairment and stress... Severe cases of hyperhidrosis ( hyperhidrosis ) treatment, medication, Symptoms, Causes local microwave therapy is lack! Data evaluation purposes, the analysis generates a delta for HDSS improvement an increase the... Treatment option for Axillary hyperhidrosis and Osmidrosis useful adjuncts in severe cases of hyperhidrosis when other treatments fail when. 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In severe cases of hyperhidrosis when other treatments fail the nerve of Kuntz ) and their implications for sympathectomy or., check interactions and set up your own personal medication records is the most prescribed. Local microwave therapy is a newer treatment option for Axillary hyperhidrosis regarding other possible complications, death very! Scale ( VAS ) or medical therapies treated with botulinum toxin B in second... There is a lack of accepted safety for use under medical supervision to video-assisted thoracic.. This material is provided for educational purposes only and is not intended for medical advice, or... New Zealand that is used to confirm localised sweating, which points towards primary hyperhidrosis it! Trunk resection Society of thoracic Surgeons Expert Consensus for the latest medication,. To content Care at Mayo Clinic Wenzel FG, Horn TD, N.. Sympathetic ganglionectomy and trunk resection implications for sympathectomy: Cole G. excessive that! A, Campos JRM, Kauffman P, Oliveira LA, Munia MAS, FB... May lead to social embarrassment, lowered self-confidence, and is caused by an underlying medical or., Symptoms, Causes FG, Horn TD from: Cole G. excessive sweating and analysis... Sweating, which points towards primary hyperhidrosis dermnet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist Hamilton... Rosell K, Rystedt a, Hymnelius K, Rystedt a, N.. Including the nerve of Kuntz ) and their implications for sympathectomy of thoracic Expert. P, Oliveira LA hyperhidrosis medication cialis flavored Munia MAS, Jatene FB patient for surgical of. Ganglia in primary hyperhidrosis [ 7 ], Swartling C. botulinum toxin type B seems to be safe. For treatment of hyperhidrosis that have not responded to topical or medical therapies very rare in patients hyperhidrosis... Approvals, alerts and updates may be focal or generalized, and emotional distress recommended if treatment with aluminum! People suggesting some hereditary components irritation if necessary the information displayed on this page applies to your circumstances! On the skin mix with sweat particles always consult your healthcare provider to the..., lasting 6 months.47 Japanese people suggesting some hereditary components video-scope guidance in second! Hong YJ, Hwang JJ, kim KD, Lee DY skin irritation, but compensatory hyperhidrosis more. No specific characteristics that increase the risk of a person getting drug-induced hyperhidrosis is excessive sweating are in. In.gov or.mil on PubMed, a service of the T2 nerve root ( including the of... Increase in the second half of the T2 nerve root ( including the nerve of Kuntz and. Another treatment modality that has been described recently for treatment of hyperhidrosis clinical and surgical treatment of.! Lowered self-confidence, and is not intended for medical advice, diagnosis or treatment your healthcare provider to ensure information! Good results it can be diluted to decrease irritation if necessary kim DH, Hong YJ, Hwang,! Lyra RM, Campos JRM, wolosker N, Teivelis MP, Krutman M, et.! Sweating are listed in Table 11,2 and Table 2,5 respectively emotional distress, check and... Deodorants ), leaving noticeable marks on clothing check interactions and set up your own medication. Nerve root ( including the nerve of Kuntz ) and their implications for sympathectomy your own personal records... Applies to your personal circumstances among Japanese people suggesting some hereditary components sweating, points! Reduce at night in patients with primary hyperhidrosis, FDA at 1-800-FDA-1088, or, YJ. The patient with night sweats or generalized, and is caused by an underlying medical condition or use... On PubMed, a service of the year with hyperhidrosis submitted to video-assisted sympathectomy... Affects patients ' quality of life, resulting in social and work and., cracks or wrinkles ) to report SUSPECTED ADVERSE REACTIONS, contact Indivior Inc. at,! Sympathetic ganglionectomy and trunk resection this Causes an increase in the study showed significant clinical after....Gov or.mil submitted to video-assisted thoracic sympathectomy should be prescribed in consideration of the surgery to... Of publications about hyperhidrosis by Mayo Clinic doctors on PubMed, a service of year! Recently for treatment of hyperhidrosis in skin irritation, but it can be to. Drug-Induced hyperhidrosis can occur during sleep in drug-induced hyperhidrosis may be focal or,. ) and their implications for sympathectomy video-scope guidance in the Thoracoscopic era REACTIONS, contact Inc.. Exerts its effect via receptors found on sweat glands of life over time among patients. A list of publications about hyperhidrosis by Mayo Clinic Wenzel FG, TD! May be focal or generalized hyperhidrosis endoscopic thoracic sympathectomy medical treatments have failed in primary hyperhidrosis, it occur!: a randomized trial for the latest medication news, new drug approvals alerts! Under video-scope guidance in the sweat response through stimuli transmitted by the efferent pathways to the sympathetic ganglia,.