Clinical features:
(1) increased sweating over face and trunk (including gustatory sweating after eating) and distal anhidrosis (sudomotor dysfunction)
(2) postural/orthostatic hypotension with or without postural syncope
(3) esophageal dysmotility with dysphagia
(4) gastroparesis with distention, vomiting and poor glycemic control
(5) postprandial or nocturnal watery diarrhea
(6) fecal incontinence due to anorectal dysfunction
(7) bladder atony with urinary retention, incontinence, urinary tract infections, hydroureter and hydronephrosis
(8) erectile dysfunction and/or impaired ejaculation in males
(9) flushing secondary to vasodilatation of capillaries and veins
(10) abnormal heart rate, often with tachyarrhythmias such as resting tachycardia
(11) abnormal pupillary findings with miosis and a reduced light reflex
(12) poor awareness of hypoglycemia
(13) heat and/or exercise intolerance
(14) silent myocardial infarction, cardiac arrest and/or sudden death
(15) brittle diabetes
(16) constipation, which may be intermittent
where:
• Postural hypotension involves a drop of systolic blood pressure >= 30 mm Hg upon standing from recumbent position, often without compensatory tachycardia.
• Drugs with sympathetic or parasympathetic activity may worsen symptoms.
• Impaired ejaculation in males may include retrograde ejaculation.
Patients with severe autonomic neuropathy have an increased mortality.
