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Neuropathy, Autonomic

Neuropathy, Autonomic is a topic covered in the 5-Minute Clinical Consult.

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  • Any neuropathic process that has predominant effects on the autonomic nervous system
  • Process targets small unmyelinated or lightly myelinated peripheral nerves.
  • Most of the time, it is caused by diabetes mellitus.


  • Approximately 7% of diabetics have signs of autonomic neuropathy at the time of diagnosis of diabetes (1).
  • Approximately 2% of type 2 and 6% of type 1 diabetics develop autonomic neuropathy each year (1).

  • The prevalence of diabetic autonomic neuropathy is estimated at 20% of diabetics.
  • Affects slightly >5 million people in the United States
  • The prevalence of all other causes of autonomic neuropathy is significantly lower.

Etiology and Pathophysiology

Autonomic neuropathy can be secondary to diabetes, hypothyroidism, amyloidosis, Guillain-Barré syndrome and other primary neuropathic processes, Parkinson disease, paraneoplastic syndromes, infectious diseases, collagen vascular diseases, nutritional deficiency, and toxic exposures (2).

Specific genetic syndromes associated with autonomic neuropathies often present in infancy with failure to thrive

Risk Factors

Autonomic effects of diabetes are most common with long-standing and poorly controlled diabetes.

General Prevention

Exercise improves cardiac autonomic function in diabetic autonomic neuropathy and improves overall autonomic function in prediabetic patients.

Commonly Associated Conditions

  • Because the autonomic neuropathy does not occur in isolation, signs of sensory neuropathy are common.
  • Sensory neuropathies have autonomic effects that are often subclinical.

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Stephens, Mark B., et al., editors. "Neuropathy, Autonomic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816059/all/Neuropathy__Autonomic.
Neuropathy, Autonomic. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816059/all/Neuropathy__Autonomic. Accessed April 20, 2019.
Neuropathy, Autonomic. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816059/all/Neuropathy__Autonomic
Neuropathy, Autonomic [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816059/all/Neuropathy__Autonomic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Neuropathy, Autonomic ID - 816059 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816059/all/Neuropathy__Autonomic PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -