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Autonomic DysfunctionAka: Dysautonomia, Autonomic Neuropathy, Chronic Autonomic Neuropathy

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  1. Types: Chronic Autonomic Failure
    1. Orthostatic Hypotension
      1. Diabetes Mellitus
      2. Amyloidosis
      3. Tabes dorsalis
      4. Multiple Sclerosis
      5. Acute Intermittent Porphyria
      6. Guillain-Barre Syndrome
      7. Toxins
        1. Vacor rat poison
        2. Arsenic
        3. Mercury
      8. Renal Failure
      9. Medications
      10. See Autonomic Neuropathy
    2. Primary Chronic Autonomic Failure (Idiopathic)
      1. Pure autonomic failure
      2. Multiple system atrophy
      3. Parkinson's Disease
    3. Chronic Orthostatic Intolerance
      1. Example: Neuropathic postural tachycardia syndrome
    4. Other causes
      1. Panic Disorder (psychogenic Ischemic Heart Disease)
      2. Neurogenic Essential Hypertension
      3. Congestive Heart Failure
      4. Chronic Fatigue Syndrome
  2. Symptoms and Signs
    1. Postural Hypotension
    2. Nocturnal Diarrhea
    3. Impotence
    4. Incomplete voiding
  3. Diagnostics: Telemetry monitoring
    1. No overshoot tachycardia on standing
    2. No variation in pulse with Valsalva maneuver
    3. No Blood Pressure (<10 mmHg) increase with hand grip
  4. Management: Orthostatic Hypotension
    1. See Vasovagal Syncope for assessment and management
  5. References
    1. Pryse-Phillips in Noble (2001) Primary Care, p. 1599
    2. Saper in Goldman (2000) Cecil Medicine, p. 2057-8
    3. Goldstein (2002) Ann Intern Med 137:753

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