Autonomic neuropathy: treatment

Aziz I Shaibani MD (Dr. Shaibani of Baylor College of Medicine has no relevant financial relationships to disclose.)
Duaa Jabari MD (Dr. Jabari of the University of Texas Houston Health Science Center has no relevant financial relationships to disclose.)
Louis H Weimer MD, editor. (Dr. Weimer of Columbia University has received consulting fees from Roche.)
Originally released September 19, 2003; last updated January 20, 2016; expires January 20, 2019

Overview

Autonomic neuropathy has numerous causes, some of them common, such as diabetic autonomic neuropathy, and others rare, such as Fabry disease, but all can produce disabling symptoms. Autonomic neuropathy can affect the sympathetic, parasympathetic, and enteric branches of the autonomic nervous system to variable degrees, causing dysfunction of different organs such as heart, intestinal tract, and urinary bladder. In this article, the authors review the available symptomatic treatments of these dysfunctions, focusing mainly on orthostatic hypotension, postural orthostatic tachycardia syndrome (POTS), gastroparesis, bladder hypomotility, and erectile dysfunction. A brief physiological and pathophysiological review and a discussion of available treatments are included for each disease discussed.

Key points

 

• Although autonomic neuropathy can be disabling, the patient's symptoms and quality of life can be improved efficiently.

 

• In general practice, postural orthostatic tachycardia syndrome (POTS) can be easily overlooked.

 

• New promising treatments are available for orthostatic hypotension, postural orthostatic tachycardia syndrome, and gastroparesis.

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