Autonomic neuropathy
Definition
Autonomic neuropathy is a group of symptoms that occur when there is damage to nerves that regulate blood pressure, heart rate, bowel and bladder emptying, digestion, and other body functions.
Alternative Names
Neuropathy - autonomic
Causes, incidence, and risk factors
Autonomic neuropathy is a form of peripheral neuropathy. It is a group of symptoms, not a specific disease. There are many causes.
Autonomic neuropathy involves damage to the nerves that run through a part of the peripheral nervous system. The peripheral nervous system includes the nerves used for communication to and from the brain and spinal cord (central nervous system) and all other parts of the body, including the internal organs, muscles, skin, and blood vessels.
Damage to the autonomic nerves affects the function of areas connected to the problem nerve. For example, damage to the nerves of the gastrointestinal tract makes it harder to move food during digestion (decreased gastric motility).
Autonomic neuropathy affects the nerves that regulate vital functions, including the heart muscle and smooth muscles.
Damage to the nerves supplying blood vessels causes problems with blood pressure and body temperature.
Autonomic neuropathy is associated with the following:
References
Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.
Vardi M, Nina A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;24(1):CD002187.
Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 207: chap 21.
Review Date: 9/25/2008
Reviewed By: Daniel B. Hoch, MD, PhD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Autonomic neuropathy
Alternative Names
Neuropathy - autonomic
Symptoms
Symptoms vary depending on the nerve(s) affected. They usually develop gradually over years.
Symptoms may include:
Digestive tract
- Constipation
- Diarrhea
- Feeling full after only a few bites (early satiety)
- Nausea after eating
- Swollen abdomen
- Unintentional loss of more than 5% of body weight
- Vomiting of undigested food
Heart
- Blood pressure changes with position
- Dizziness that occurs when standing up
Urinary tract
Other symptoms
Signs and tests
A medical history and general physical exam are critical. A brain and nervous system (neurological) examination may show evidence of injury to other nerves. However, it is very difficult to directly test for autonomic nerve damage.
Signs of autonomic neuropathy include:
- Abnormal sounds in the abdomen, indicating decreased gastric movement (motility)
- Decrease of blood pressure upon standing up (postural hypotension)
- Sluggish pupil reaction in the eye
- Swollen (distended) abdomen
- Swollen (distended) bladder
Occasionally, other symptoms may indicate a problem in the function of the autonomic nervous system, including:
Special measurements of sweating and heart rate are called "autonomic testing" and can assist in diagnosis and treatment.
Other tests include:
Measurement of blood pressure lying down, sitting, and standing
Measurement of changes in heart rate
- Esophagogastroduodenoscopy (EGD)
- Isotope study
- Voiding cystourethrogram (VCUG) or other tests of bladder function
Other tests for autonomic neuropathy are based on the suspected cause of the disorder, as suggested by the history, symptoms, and the way symptoms developed.
References
Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.
Vardi M, Nina A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;24(1):CD002187.
Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 207: chap 21.
Review Date: 9/25/2008
Reviewed By: Daniel B. Hoch, MD, PhD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Autonomic neuropathy
Alternative Names
Neuropathy - autonomic
Treatment
Treatment is supportive and may need to be long-term. Several treatments may be attempted before a successful one is found.
Various strategies may be used to reduce symptoms in the feet, legs, and arms. These include:
Florinef and salt tablets to increase fluid volume in blood vessels
Fludrocortisone or similar medications to reduce postural hypotension
Medications to help with salt and fluid retention
Proamatine to prevent a drop in blood pressure when standing
Sleeping with the head raised
Use of elastic stockings
Treatments for reduced gastric motility include:
Diarrhea, constipation, bladder problems, and other symptoms are treated as appropriate. These symptoms may respond poorly to treatment. Drugs that block bladder contractions may be used to help with urinary control problems.
Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.
Expectations (prognosis)
The outcome varies. If the cause can be found and treated, there is a chance that the nerves may repair or regenerate. The symptoms may improve with treatment, or they may continue or get worse, even with treatment.
Most symptoms of autonomic neuropathy are uncomfortable, but they are rarely life-threatening.
Complications
- Fluid or electrolyte imbalance such as low blood potassium (if excessive vomiting or diarrhea)
- Injuries from falls (with postural dizziness)
- Kidney failure (from urine backup)
- Malnutrition
- Psychological/social effects of impotence
Calling your health care provider
Call for an appointment with your health care provider if you have symptoms of autonomic neuropathy. Early symptoms might include:
Becoming faint or light-headed when standing
Changes in bowel, bladder, or sexual function
Unexplained nausea and vomiting when eating
Early diagnosis and treatment increases the likelihood of controlling symptoms.
References
Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.
Vardi M, Nina A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;24(1):CD002187.
Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 207: chap 21.
Review Date: 9/25/2008
Reviewed By: Daniel B. Hoch, MD, PhD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Autonomic neuropathy
Alternative Names
Neuropathy - autonomic
Prevention
Preventing or controlling disorders associated with autonomic neuropathy may reduce the risk. For example, diabetics should closely control blood sugar levels. Alcoholics should stop drinking.
References
Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.
Vardi M, Nina A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;24(1):CD002187.
Benarroch E, Freeman R, Kaufman H. Autonomic nervous system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 207: chap 21.
Review Date: 9/25/2008
Reviewed By: Daniel B. Hoch, MD, PhD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
