The clinical features of non-diabetic autonomic failure

Eighty patients with symptomatic autonomic failure were referred to one physician. A definite diagnosis was made from suggestive symptoms and severely abnormal cardiovascular reflex tests. Just over half had 'primary' autonomic failure (PAF), either associated with Parkinsonism (PD), multiple system atrophy (MSA) or alone (PAF). The remainder had 'secondary' causes, which were empirically classified into five groups--associated with amyloidosis, peripheral neuropathies, carcinomas, as part of a complex clinical picture, and a number of miscellaneous causes. Diabetic patients were excluded from this series. The majority with PD or MSA were referred by neurologists, while most of those with PAF or secondary autonomic failure were referred by physicians. A high proportion of patients with MSA, amyloidosis and carcinomas are now dead. Autonomic failure may present in a variety of ways and to any medical speciality. Awareness of the possibility of an autonomic component in any complex clinical problem is a prerequisite to correct diagnosis and appropriate treatment.