What tests may be performed to identify systemic disorders causing secondary pandysautonomia?

Updated: Oct 21, 2018
  • Author: Mohini Gurme, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Tests for other systemic disorders causing secondary pandysautonomia may be ordered according to clues from the history.

  • Glycosylated hemoglobin or glucose tolerance test may be indicated to test for diabetes.

  • Anti-Hu antibody titers may be needed if the patient has associated sensory neuropathy or cognitive changes.

  • Anti-calcium channel antibody titers for Lambert-Eaton myasthenic syndrome (LEMS), a presynaptic disorder of neuromuscular transmission, are sometimes associated with acute or subacute autonomic symptoms. About one half of patients have an associated neoplasm. As many as 80% of these may be small cell lung cancer. Patients may give a history of smoking or recent weight loss.

  • In cases of suspected poisoning by food or wound contamination, screen stool for botulinum by culture and detection of toxin. Botulism is another presynaptic disorder of neuromuscular transmission that may be associated with autonomic symptoms. However, a negative result does not exclude the possibility of botulism. Consultation with the Centers for Disease Control and Prevention may be a prerequisite of ordering the test because of heightened bioterrorism surveillance.

  • Serum and urine protein electrophoresis may be ordered to evaluate myeloma with amyloidosis, or genetic testing to evaluate for familial amyloidosis.

  • Rapid plasma reagent (RPR) or Venereal Disease Research Laboratory test (VDRL) may be needed to test for syphilis.

  • HIV testing may be indicated.

  • Autoimmune screening helps to evaluate for collagen-vascular disease. This testing may include antinuclear antibody levels, erythrocyte sedimentation rate, and other autoimmune tests (eg, rheumatoid factor, SS-A and SS-B antibodies), as the clinical syndrome dictates.

  • Assessment of the urinary porphyrins and erythrocyte porphobilinogen deaminase levels are indicated if the clinical history suggests the possibility of porphyria.


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