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Autonomic Neuropathy

Dysfunction of the Autonomic Nervous System

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Autonomic Neuropathy?

Autonomic neuropathy refers to damage to autonomic nerves controlling involuntary bodily functions, including cardiovascular, gastrointestinal, genitourinary, sudomotor (sweat), pupillary, and metabolic systems.

Etiologies: diabetes (most common, 25-50% of long-standing diabetics), amyloidosis, autoimmune (paraneoplastic, ganglionic AChR antibody, GFAP), genetic (familial dysautonomia, hereditary sensory and autonomic neuropathy), infectious (Lyme, HIV, Chagas), nutritional (B12 deficiency, alcohol), toxic (chemotherapy, heavy metals).

Pure autonomic failure: rare, predominantly affects autonomic system without other neurological signs.

Multiple system atrophy (MSA): autonomic failure plus extrapyramidal/cerebellar signs.

Pathophysiology: damage to small unmyelinated C-fibers and small myelinated A-delta fibers; postganglionic sympathetic denervation predominates in many forms.

Diagnostic challenge: symptoms multisystem, often subtle, requires specific autonomic testing.

Symptoms

Cardiovascular: orthostatic hypotension (drop over 20 mmHg systolic on standing), syncope, supine hypertension, exercise intolerance, fixed heart rate without variability.
Gastrointestinal: gastroparesis (early satiety, postprandial bloating, vomiting), dysphagia, constipation, diarrhea (especially nocturnal), fecal incontinence.
Genitourinary: erectile dysfunction (often early sign in men), retrograde ejaculation, decreased vaginal lubrication, urinary retention, urgency, incomplete emptying.
Sudomotor: anhidrosis (dry skin) in distal extremities, hyperhidrosis (compensatory) in trunk.
Pupillary: anisocoria, sluggish or absent reactivity, accommodation paralysis.
Metabolic: hypoglycemia unawareness in diabetics, fasting hypoglycemia.
Other: heat intolerance, fatigue, reduced exercise tolerance.
Neurogenic orthostatic hypotension: no compensatory tachycardia despite blood pressure drop.

Risk Factors

Diabetes mellitus (long duration, poor glycemic control).
Older age (autonomic decline with aging).
Family history of dysautonomia or hereditary neuropathies.
Autoimmune diseases: lupus, Sjögren syndrome, autoimmune autonomic ganglionopathy.
Cancer (paraneoplastic, especially small cell lung cancer).
Amyloidosis (AL or hereditary).
Chemotherapy (especially platinum-based, vinca alkaloids).
Heavy alcohol use.
B12 or thiamine deficiency.
Parkinson disease, multiple system atrophy.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Lightheadedness or syncope on standing.
  • Persistent gastrointestinal symptoms (gastroparesis, severe constipation).
  • Erectile dysfunction in young diabetic.
  • Bladder dysfunction with retention or incontinence.
  • Sweating abnormalities (drying out, heat intolerance).
  • Hypoglycemia unawareness in diabetics.
  • Multiple unexplained autonomic symptoms.
  • Family history of autonomic disorders or genetic syndromes.

Treatment Methods

01
Diagnostic workup: comprehensive autonomic function tests (heart rate variability, Valsalva maneuver, tilt-table test, QSART for sweat function, gastric emptying study, urodynamic study).
02
Specialist autonomic testing centers preferred for complex cases.
03
Etiologic workup: HbA1c, fasting glucose, B12, thiamine, paraneoplastic and autonomic antibodies, amyloid screen, genetic testing.
04
MRI brain (rule out MSA, structural causes).
05
Treatment is etiology-specific and symptomatic:
06
Orthostatic hypotension: increased salt and fluids, compression stockings, head-up tilt sleeping, midodrine, fludrocortisone, droxidopa.
07
Gastroparesis: small frequent meals, low-fat low-fiber diet, prokinetics (metoclopramide, domperidone, erythromycin), gastric pacing in refractory cases.
08
Constipation: fiber, hydration, polyethylene glycol, prucalopride, linaclotide.
09
Erectile dysfunction: PDE5 inhibitors (sildenafil, tadalafil), intracavernosal injections, vacuum devices.
10
Bladder dysfunction: timed voiding, intermittent catheterization, anticholinergics, alpha-blockers.
11
Hyperhidrosis: anticholinergics, glycopyrrolate; anhidrosis: avoid heat exposure.
12
Diabetic autonomic neuropathy: tight glycemic control (especially DCCT/EDIC evidence in T1DM).
13
Autoimmune forms: IVIG, plasmapheresis, rituximab, corticosteroids based on antibody profile.
14
Multidisciplinary care: neurology, cardiology, gastroenterology, urology, endocrinology, physical therapy.
15
Patient education: symptom recognition, fall prevention, medication compliance, lifestyle modifications.
16
Long-term: regular autonomic function reassessment, screen for new symptom domains, address quality of life.

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.