Merck Manual

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Autonomic Neuropathies


Phillip Low

, MD, College of Medicine, Mayo Clinic

Last full review/revision Sep 2021| Content last modified Sep 2022
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Autonomic neuropathies are peripheral nerve disorders with disproportionate involvement of autonomic fibers.

Autoimmune autonomic neuropathy is an idiopathic disorder that often develops after a viral infection; onset may be subacute.

Autonomic insufficiency is usually a late manifestation in alcoholic neuropathy.

Symptoms and Signs of Autonomic Neuropathies

Diagnosis of Autonomic Neuropathies

  • Clinical evaluation

Autoimmune autonomic neuropathy may be suspected after a viral infection.

Ganglionic anti–acetylcholine receptor antibody A3 is present in about half of patients with autoimmune autonomic neuropathy and is occasionally present in patients with other autonomic neuropathies.

Treatment of Autonomic Neuropathies

  • Treatment of underlying disorders

  • Sometimes immunotherapy, plasma exchange, or IV gamma-globulin

Underlying disorders are treated, as are symptoms.

Autoimmune autonomic neuropathy may respond to immunotherapy; plasma exchange or IV gamma-globulin can be used for more severe cases.

Key Points

  • Diagnose based on identifying symptoms due to autonomic failure (eg, orthostatic hypotension, neurogenic bladder, erectile dysfunction, gastroparesis, intractable constipation) and a cause of neuropathy.

  • Treat underlying disorders if identified; try immunotherapy if autoimmune autonomic insufficiency is diagnosed or, if symptoms are severe, plasma exchange or IV gamma-globulin.

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