From the Guidelines
Autonomic dysfunction can be caused by a variety of conditions, including diabetes, kidney or liver failure, alcohol abuse, and certain medications, with the most recent evidence suggesting that damage to the autonomic nervous system is a key factor 1. The causes of autonomic dysfunction are diverse and can be categorized into primary and secondary causes. Primary causes include neurodegenerative disorders, while secondary causes involve damage to the autonomic nervous system due to other diseases.
- Diabetes mellitus is a major cause of autonomic dysfunction, as it can damage nerves over time due to prolonged high blood sugar levels.
- Kidney or liver failure can also lead to autonomic dysfunction, as these conditions can cause damage to the autonomic nervous system.
- Alcohol abuse is another significant cause of autonomic dysfunction, as it can damage the autonomic nervous system and lead to a range of symptoms.
- Certain medications, such as tricyclic antidepressants, phenothiazines, and antihistamines, can also cause autonomic dysfunction as a side effect. The underlying mechanism of autonomic dysfunction typically involves damage to autonomic nerve fibers, disruption of neurotransmitter function, or interference with central nervous system regulation of autonomic processes.
- A neurological evaluation is warranted in cases of autonomic dysfunction, particularly if accompanied by other autonomic signs or symptoms, such as impotence or disturbed micturition 1.
- The presence of other neurological signs, such as Parkinsonism, or certain drugs, like antidepressives, can help distinguish between causes of autonomic dysfunction. It is essential to note that the pattern of autonomic failure does not depend in a clear manner on the primary disorder, making diagnosis and treatment challenging 1.
- Recent studies have also highlighted the importance of genetic factors in autonomic dysfunction, with certain genetic mutations increasing the vulnerability to autonomic dysfunction 1.
- However, the most recent and highest quality study on the topic is from 2021, which provides guidance on the management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy, including the evaluation and workup for autonomic dysfunction 1.
From the Research
Causes of Autonomic Dysfunction
- Autoimmune disorders, such as autoimmune autonomic ganglionopathy (AAG), paraneoplastic autonomic neuropathy, and acute autonomic and sensory neuropathy, can cause autonomic dysfunction 2, 3
- Systemic autoimmune diseases, such as diabetes mellitus, amyloidosis, and immune-mediated illnesses, can also lead to autonomic dysfunction 2, 4, 5
- Neurodegenerative diseases, including Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, and pure autonomic failure, can cause autonomic dysfunction 4
- Infections, such as Lyme disease, can also lead to autonomic dysfunction, although this is not a primary cause 6
- Other factors, such as inflammation and immune responses, can also contribute to autonomic dysfunction 3, 5
Specific Causes
- Autoantibody biomarkers, such as antibodies targeting the α3 subunit of the ganglionic-type nicotinic acetylcholine receptor (α3gAChR), can be detected in some cases of autonomic dysfunction 2
- Paraneoplastic antibodies, such as antineuronal nuclear antibody, type 1 (ANNA-1: anti-Hu), can also be associated with autonomic dysfunction 2
- Diabetes and its treatment can alter autonomic function and increase the risk of cardiovascular complications 5