Autonomic neuropathy is a possible complication of a number of diseases, and the tests you'll need often depend on your symptoms and risk factors for autonomic neuropathy.
When you have known risk factors for autonomic neuropathy
If you have conditions that increase your risk of autonomic neuropathy (such as diabetes) and have symptoms of the condition, extensive testing may not be necessary. Your doctor may perform a physical exam and ask about your symptoms.
If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.
When you don't have risk factors for autonomic neuropathy
If you have symptoms of autonomic neuropathy but don't have risk factors, the diagnosis may be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.
Your doctor may perform tests to evaluate autonomic functions, which may include:
June 06, 2015
- Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.
A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
- Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
- Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through four capsules placed on your forearm, foot and leg, while a computer analyzes the response of your nerves and sweat glands. You may feel warmth or a tingling sensation during the test.
- Thermoregulatory sweat test. During this test, you're coated with a powder that changes color when you sweat. While lying in a chamber with slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
- Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary symptoms, a series of urine tests can evaluate bladder function.
- Ultrasound. If you have bladder symptoms, your doctor may do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.
- Gardner DG, et al. Pancreatic Hormones and Diabetes Mellitus. In: Greenspan's Basic & Clinical Endocrinology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://accessmedicine.com. Accessed May 4, 2015.
- Callaghan BC, et al. Diabetic neuropathy: Clinical manifestations and current treatments. The Lancet Neurology. 2012;11:521. Accessed May 12, 2015.
- Stevens MJ. Diabetic autonomic neuropathy. http://www.uptodate.com/home. Accessed April 30, 2015.
- Tesfaye S, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285. Accessed May 13, 2015.
- Longo DL, et al., eds. Disorders of the Autonomic Nervous System. In: Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com. Accessed May 4, 2015.
- Diabetic neuropathies: The nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/. Accessed May 4, 2015.
- Overview of the autonomic nervous system. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/overview-of-the-autonomic-nervous-system. Accessed May 4, 2015.
- Philips JC, et al. Squatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes. Diabetes & Metabolism. 2011;37:489.
- Bethanechol (prescribing information). Pomona, N.Y.: Barr Laboratories, Inc.; 2007. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=80ee6156-18b8-45aa-9402-b40647173da8. Accessed May 4, 2015.
- Detrol (prescribing information). New York, N.Y.: Pharmacia and Upjohn; 2012. http://labeling.pfizer.com/ShowLabeling.aspx?id=719. Accessed May 4, 2015.
- Ditropan (prescribing information). Raritan, N.J.: Ortho McNeil Pharmaceuticals; 2011. http://www.janssenpharmaceuticalsinc.com/assets/ditropanxl.pdf. Accessed May 4, 2015.
- Hirsch M, et al. Tricyclic and tetracyclic drugs: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed May 13, 2015.
- Robinul and Robinul Forte (prescribing information). Atlanta, Ga.: Shionogi Pharma, Inc.; 2010. http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/017558s053lbl.pdf. Accessed May 4, 2015.
- Shakher J, et al. Update on the management of diabetic polyneuropathies. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2011;4:289.
- Wang CP, et al. A single-blinded, randomized pilot study evaluating effects of electroacupuncture in diabetic patients with symptoms suggestive of gastroparesis. The Journal of Alternative and Complementary Medicine. 2008;7:833.
- Feldman, EL, et al. Treatment of diabetic neuropathy. http://uptodate.com/home. Accessed April 30, 2015.
- Rutkove SB. Overview of polyneuropathy. http://uptodate.com/home. Accessed April 30, 2015.
- Olshansky B. Upright tilt table testing in the evaluation of syncope. http://uptodate.com/home. Accessed April 30, 2015.
- Tesfaye S. Neuropathy in diabetes. Medicine. 2015;43:26. Accessed May 13, 2015.
- Coon E (expert opinion). Mayo Clinic, Rochester, Minn. May 14, 2015.