Autonomic dysfunction

At a glance

• The autonomic nervous system controls BP, heart rate, gut motility, bladder, sexual function, sweating and pupils. Failure shows up most often as orthostatic hypotension, gastroparesis, neurogenic bladder and erectile dysfunction.
• Diabetes is the commonest cause. The synucleinopathies (Parkinson disease, multiple system atrophy, dementia with Lewy bodies, pure autonomic failure) are the main primary causes.
• Neurogenic orthostatic hypotension (nOH) has a blunted heart rate response. Its treatment trades daytime upright BP against supine hypertension at night.