Outline of investigations in autonomic diseases
| *Indicates screening autonomic tests used in our London Unit. | |
| Adapted from Mathias CJ, Bannister R, eds. Investigation of autonomic disorders. In: Autonomic failure: a textbook of clinical disorders of the autonomic nervous system, 4th ed. Oxford: Oxford University Press, 2002: 342–56. | |
| ▸Cardiovascular | |
| Physiological | Head-up tilt (60°)*; standing*; Valsalva maneouvre* |
| Pressor stimuli* (isometric exercise, cutaneous cold, mental arithmetic) | |
| Heart rate responses—deep breathing*, hyperventilation*, standing*, head-up tilt*, 30:15 R-R interval ratio | |
| Liquid meal challenge | |
| Modifed exercise testing | |
| Carotid sinus massage | |
| Biochemical | Plasma noradrenaline: supine and head-up tilt or standing; urinary catecholamines; plasma renin activity, and aldosterone |
| Pharmacological | Noradrenaline: α adrenoceptors, vascular |
| Isoprenaline: β adrenoceptors, vascular and cardiac | |
| Tyramine: pressor and noradrenaline response | |
| Edrophonium: noradrenaline response | |
| Atropine: parasympathetic cardiac blockade | |
| ▸Endocrine | Clonidine—α 2 adrenoceptor agonist: noradrenaline suppression; growth hormone stimulation |
| ▸Sudomotor | Central regulation—thermoregulatory sweat test |
| Sweat gland response to intradermal acetylcholine, quantitative sudomotor axon reflex test (Q-SART), localised sweat test | |
| Sympathetic skin response | |
| ▸Gastrointestinal | Video-cinefluoroscopy, barium studies, endoscopy, gastric emptying studies, transit time, lower gut studies |
| ▸Renal function and urinary tract | Day and night urine volumes and sodium/potassium excretion |
| Urodynamic studies, intravenous urography, ultrasound examination, sphincter electromyography | |
| ▸Sexual function | Penile plethysmography |
| Intracavernosal papaverine | |
| ▸Respiratory | Laryngoscopy |
| Sleep studies to assess apnoea and oxygen desaturation | |
| ▸Eye and lacrimal function | Pupillary function, pharmacological and physiological |
| Schirmer’s test | |