Differential Diagnosis

The patient's complaint of an "automatic system" being "wild in the morning" suggests a condition related to the autonomic nervous system or a disorder with symptoms that are worse in the morning. Here's a differential diagnosis based on the provided information:

• Single Most Likely Diagnosis

  • Orthostatic Hypotension: This condition is characterized by a sudden drop in blood pressure when standing up, which can lead to symptoms such as dizziness, lightheadedness, and fainting. It's more pronounced in the morning due to overnight dehydration and changes in blood volume distribution. The autonomic nervous system plays a crucial role in regulating blood pressure, and its dysfunction could lead to such symptoms.

• Other Likely Diagnoses

  • Diabetes: Morning hyperglycemia can lead to symptoms like increased heart rate, sweating, and tremors due to the body's stress response to high blood sugar levels. The autonomic nervous system is involved in glucose regulation.
  • Anxiety Disorders: Morning anxiety can manifest with symptoms of a "wild" autonomic system, including rapid heart rate, sweating, and tremors. Anxiety can be worse in the morning for some individuals.
  • Hypothyroidism: Some patients with hypothyroidism may experience morning symptoms such as palpitations, tremors, and sweating due to the body's metabolic slowdown and potential autonomic dysfunction.

• Do Not Miss Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that produces excess catecholamines, leading to episodes of hypertension, tachycardia, sweating, and palpitations. These episodes can occur at any time, including the morning, and are life-threatening if not diagnosed and treated.
  • Autonomic Dysfunction due to Neurodegenerative Diseases: Conditions like Parkinson's disease, multiple system atrophy, or pure autonomic failure can lead to significant autonomic dysfunction, which might be more noticeable in the morning.

• Rare Diagnoses

  • Dopamine-Sensitive Dystonia: A rare condition characterized by involuntary muscle contractions that are typically worse in the morning and can be dramatically improved by dopamine agonists or levodopa.
  • Circadian Rhythm Sleep Disorders: Although not directly related to the autonomic system, disorders of the body's internal clock can lead to morning symptoms due to the misalignment of the sleep-wake cycle with the external environment.

Each of these diagnoses requires a thorough medical history, physical examination, and potentially specific diagnostic tests to confirm the presence of the condition. The justification for each diagnosis is based on the potential for the condition to cause symptoms that are worse in the morning and involve the autonomic nervous system.