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 ¹. 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 ². 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 ¹. In diabetic autonomic neuropathy, gastroparesis can occur, leading to delayed gastric emptying ².

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 ²,³.

Thermoregulatory abnormalities may present as temperature dysregulation or abnormal sweating patterns ¹,³.

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 ¹. They are also key considerations in Type 1 diabetes and Parkinson's disease, where autonomic neuropathy is a well-recognised complication ²,³.