This review highlights the diverse clinical presentations of autonomic neuropathies and emphasizes that several specific autonomic syndromes have potential targeted treatments.
Encourages evaluation for treatable autonomic neuropathies in diabetes; leaves open prospective validation of specific interventions.
A limited autonomic neuropathy may underlie some unusual clinical syndromes, including the postural tachycardia syndrome, pseudo-obstruction syndrome, heat intolerance, and perhaps chronic fatigue syndrome. Antibodies to autonomic structures are common in diabetes, but their specificity is unknown. The presence of autonomic failure worsens prognosis in the diabetic state. Some autonomic neuropathies are treatable. Familial amyloid polyneuropathy may respond to liver transplantation. There are anecdotal reports of acute panautonomic neuropathy responding to intravenous gamma globulin. Orthostatic hypotension may respond to erythropoietin or midodrine.
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Phillip A. Low (1998) studied this question.
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