What is the role of lab studies in the workup of autonomic failure syndromes?

Updated: Oct 21, 2018
  • Author: Mohini Gurme, MD; Chief Editor: Selim R Benbadis, MD  more...
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  • The patient's clinical history directs the evaluation of orthostatic hypotension and autonomic failure.

    • An acute onset of autonomic symptoms without other neurologic problems or with features such as, subtle weakness, or numbness, should prompt an evaluation for acute inflammatory demyelinating polyneuropathy (AIDP). Elevated cerebrospinal fluid (CSF) protein levels without notable cellularity may be seen (albuminocytologic dissociation) but may take several days to develop.

    • A subacute onset without other neurologic or systemic findings may indicate autoimmune autonomic neuropathy (AAN). Ganglionic AChR antibody titers can be measured. [2, 3] These antibodies are different from the antibodies against nicotinic muscle AChRs seen in myasthenia gravis.

    • A chronic onset should trigger a search for other neurologic abnormalities. In particular, evaluation for Parkinson's disease and MSA is essential. A few patients with classic idiopathic Parkinson's disease have autonomic failure early in the course of the illness. No specific laboratory test is useful for confirming this diagnosis.

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