Biochemical and pharmacologic assessment of autonomic function

Autonomic failure produces distinct pathophysiological abnormalities that differ according to the site and nature of the lesion(s). Although the anatomic organization and processes mediating chemical neurotransmission in the autonomic nervous system facilitate clinical investigation, limited access to the central compartment hampers evaluation of central neurotransmitter metabolism and neuropeptide function. As illustrated in the discussions of noradrenergic and cholinergic function, several indirect strategies have been used to assess the biochemical and neuropharmacologic consequences of autonomic dysfunction. The methods validated in patients with autonomic failure can be applied to investigate autonomic function in other clinical disorders including Parkinson's disease. The results of such studies may help to guide therapy and develop improved strategies for managing those patients with autonomic insufficiency.