Differential Diagnosis for Dysautonomia

The following differential diagnosis is organized into categories to help guide the diagnostic process.

• Single Most Likely Diagnosis

  • Postural Orthostatic Tachycardia Syndrome (POTS): This is often considered the most likely diagnosis for patients presenting with dysautonomia, characterized by a rapid heart rate and other symptoms that occur upon standing.

• Other Likely Diagnoses

  • Autonomic Dysfunction associated with Diabetes: Diabetes can cause autonomic neuropathy, leading to dysautonomia symptoms such as orthostatic hypotension, gastrointestinal disturbances, and genitourinary symptoms.
  • Multiple System Atrophy (MSA): A neurodegenerative disorder that affects the autonomic nervous system, leading to symptoms like orthostatic hypotension, urinary incontinence, and tremors.
  • Autoimmune Autonomic Ganglionopathy: An autoimmune disorder that targets the autonomic ganglia, resulting in widespread autonomic dysfunction.

• Do Not Miss Diagnoses

  • Myocardial Infarction or Cardiac Arrhythmias: Although less common, cardiac issues can present with symptoms similar to dysautonomia, such as palpitations or syncope, and are critical to diagnose promptly.
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, tachycardia, and other symptoms that might be mistaken for dysautonomia.
  • Neurodegenerative Diseases (e.g., Parkinson's Disease, Lewy Body Dementia): These conditions can have autonomic dysfunction as part of their clinical presentation and are crucial to identify due to their implications for management and prognosis.

• Rare Diagnoses

  • Familial Dysautonomia (Riley-Day Syndrome): A rare genetic disorder that affects the development of the autonomic nervous system, leading to severe dysautonomia.
  • Pure Autonomic Failure: A rare condition characterized by progressive autonomic dysfunction without other neurodegenerative features.
  • Dopamine Beta-Hydroxylase Deficiency: A rare genetic disorder that affects the synthesis of norepinephrine, leading to severe orthostatic hypotension and other autonomic symptoms.