Overview
Disorders of the sympathetic nervous system encompass a range of conditions characterized by abnormal stress responses, including autonomic dysreflexia, exaggerated blood pressure fluctuations, and diminished sympathetic function leading to postural hypotension and impaired stress adaptation 1.Diagnosis
Clinical Presentation: Episodic hypertension, hypotension, postural hypotension, and impaired stress responses 1.
Neurological Assessment: Evaluate for spinal cord injuries, peripheral neuropathy, and baroreceptor function 1.
Laboratory Tests: Measure plasma noradrenaline levels to assess sympathetic nervous system activity 23.
Regional Analysis: Consider regional noradrenaline spillover measurements for organ-specific sympathetic tone assessment 2.Management
Sympathetic Support: For postural hypotension, consider fludrocortisone or midodrine; specific dosing not detailed 1.
Heart Failure Management: Optimize treatment for underlying heart failure to preserve sympathetic neuronal norepinephrine stores 1.
Neuroprotective Strategies: Manage underlying causes such as diabetes and renal failure to prevent further sympathetic neuropathy 1.
Stress Management: Implement non-pharmacological interventions to mitigate stress responses in patients with impaired sympathetic function 1.Special Populations
Diabetes and Renal Disease: Increased risk of peripheral sympathetic neuropathy leading to postural hypotension and heat intolerance 1.
Elderly: Higher susceptibility to exaggerated blood pressure responses due to potential baroreceptor dysfunction 1.Key Recommendations
Monitor Plasma Noradrenaline Levels to assess sympathetic nervous system activity in patients with suspected autonomic dysfunction (Evidence: Moderate 23).
Address Underlying Conditions such as diabetes and renal failure to prevent progression of sympathetic neuropathy (Evidence: Moderate 1).
Use Sympathomimetics like midodrine for symptomatic treatment of postural hypotension in appropriate patients (Evidence: Expert opinion 1).References
1 Ziegler MG, Ruiz-Ramon P, Shapiro MH. Abnormal stress responses in patients with diseases affecting the sympathetic nervous system. Psychosomatic medicine 1993. link
2 Esler MD, Hasking GJ, Willett IR, Leonard PW, Jennings GL. Noradrenaline release and sympathetic nervous system activity. Journal of hypertension 1985. link
3 Goldstein DS, McCarty R, Polinsky RJ, Kopin IJ. Relationship between plasma norepinephrine and sympathetic neural activity. Hypertension (Dallas, Tex. : 1979) 1983. link