What are the key clinical features to consider when diagnosing autonomic dysfunction in a primary care setting?

When considering autonomic dysfunction in a primary care setting, it is crucial to assess a range of clinical features affecting multiple body systems, as dysautonomia is a common comorbidity of systemic diseases Blitshteyn 2025.

Cardiovascular features often include orthostatic intolerance, which can manifest as dizziness, lightheadedness, or palpitations upon standing NICE NG206. Orthostatic hypotension, a significant drop in blood pressure upon standing, and resting tachycardia are also important indicators, particularly in conditions like Type 1 diabetes where cardiovascular autonomic neuropathy is a known complication NICE NG17. Cardiac dysfunction from an autonomic perspective is also highlighted in literature Ibrahim et al. 2019.

Gastrointestinal symptoms are frequently reported and can include nausea, abdominal pain, bloating, constipation, and diarrhoea NICE NG206. In diabetic autonomic neuropathy, gastroparesis can occur, leading to delayed gastric emptying NICE NG17.

Genitourinary manifestations involve bladder dysfunction, such as urgency or frequency, and erectile dysfunction, which are common in conditions like Parkinson's disease and Type 1 diabetes NICE NG17,NICE NG71.

Thermoregulatory abnormalities may present as temperature dysregulation or abnormal sweating patterns NICE NG206,NICE NG71.

These features are particularly relevant in the context of conditions commonly managed in primary care, such as Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS), where autonomic dysfunction is a core symptom domain NICE NG206. They are also key considerations in Type 1 diabetes and Parkinson's disease, where autonomic neuropathy is a well-recognised complication NICE NG17,NICE NG71.