Pure Autonomic Insufficiency: What is it? Symptoms, Types and Treatment

Definition: Autonomic dysfunction develops when the autonomic nervous system presents insufficiency.

The CNS (central nervous system) is the most common type of autonomic dysfunction. The treatment depends on the severity of the autonomic dysfunction and its cause.

The autonomic nervous system controls several essential functions, including:

  • Heart rate.
  • Body temperature.
  • Breathing frequency.
  • Digestion.

Usually, it is not necessary to consciously think and work on these bodily systems. The autonomic nervous system connects your brain and certain parts of the body, including the internal organs.

For example, it connects with the heart, liver, sweat glands, and even the inner muscles of your eyes.

The autonomic nervous system includes the sympathetic autonomic nervous system (SNAS) and the parasympathetic autonomic nervous system (SNAP). Most organs have nerves in the sympathetic and parasympathetic systems.

The SNAS usually stimulates the organs. For example, it increases the heart rate and blood pressure when necessary. SNAP generally slows down bodily processes.


For example, it reduces heart rate and blood pressure. However, SNAP stimulates digestion, and the urinary system and SNAS slow them down.

The primary responsibility of the SNAS is to activate emergency responses when necessary. These fight or flight responses prepare you to respond to stressful situations. The SNAP conserves its energy and restores the tissues for ordinary functions.

What is autonomic dysfunction?

Autonomic dysfunction develops when the nerves of the autonomic nervous system are atrophied. This condition is also called autonomic neuropathy.

The autonomic dysfunction can vary from mild to life-threatening. It can affect part of the nervous system or everything.

Sometimes, the conditions that cause damage are temporary and reversible. Others are chronic and may continue to get worse over time.

Diabetes and Parkinson’s disease are two examples of chronic conditions that can lead to autonomic dysfunction.


The autonomic dysfunction can affect a small part of the autonomic nervous system. Some symptoms that may indicate the presence of a disorder of the autonomic nervous system include:

  • Dizziness and fainting when getting up, or orthostatic hypotension.
  • An inability to alter heart rate with exercise or intolerance to exercise.
  • Abnormal sweating could alternate between sweating too much and not sweating enough.
  • Digestive difficulties, such as loss of appetite, bloating, diarrhea, constipation, or difficulty swallowing.
  • Urinary problems, such as difficulty starting urination, incontinence, and incomplete emptying of the bladder.
  • Sexual problems in men include difficulty with ejaculation or maintaining an erection.
  • Sexual problems in women, such as vaginal dryness or difficulty having an orgasm.
  • Vision problems, such as blurred vision or inability to react to light quickly
  • You may experience any or all of these symptoms, and the effects may be mild or severe.

Orthostatic hypotension and a milder form called “orthostatic intolerance” are two of the most common conditions due to autonomic dysfunction.

Orthostatic intolerance occurs when blood pressure decreases as you get up. This can cause dizziness, fainting, and heart palpitations.

Symptoms such as tremors and muscle weakness may occur due to specific autonomic dysfunction.

Types of autonomic dysfunction.

Different types of autonomic dysfunction can vary in symptoms and severity and come from different underlying causes. Certain types of autonomic dysfunction can be very sudden and severe but also reversible.

The different types of autonomic dysfunction include:

  1. Multiple system atrophy (ASM).

MSA is a fatal form of autonomic dysfunction. It has symptoms similar to Parkinson’s disease but with a faster progression. People with this condition usually have a life expectancy of about five to 10 years from their diagnosis.

It is a rare disorder that usually occurs in adults over 40. The cause of ASM is unknown, and no cure or treatment slows the disease.

2. The syndrome of orthostatic postural tachycardia (STPO).

STPO is the most common type of autonomic dysfunction. It can affect adolescents and adults and is often associated with other clinical conditions such as Ehlers-Danlos syndrome.

Symptoms can vary from mild to severe. People with mild symptoms can continue with their daily lives, including attending school or work and participating in social and recreational activities. Those with more severe symptoms may experience restrictions.

Possible causes of STPO include:

  • Multiple sclerosis.
  • Mitochondrial diseases.
  • Lyme’s disease.

3. Neurocardiogenic syncope (CNS)

The CNS is the most common type of autonomic dysfunction. Some cases of CNS are pretty mild, with people who rarely experience symptoms. Some symptoms can indicate serious underlying health problems.

A sudden decrease in the flow of blood to the brain causes fainting. The causes can vary, and CNS injuries can often be as much of a concern as the cause.

Hereditary sensory and autonomic neuropathies (NSAH).

The NSAH is a group of related genetic disorders that cause widespread nervous dysfunction in children and young adults.

Family dysautonomia is found in this group of diseases. NSAHs often begin in childhood. A symptom can be an inability to feel pain, and it can cause a loss of feeling. A genetic mutation causes it.

4. Holmes-Adie Syndrome (SHA)

The SHA mainly affects the nerves that control the eye muscles, causing vision problems. One eye will probably be larger than the other and will contract slowly in bright light.

Deep tendon reflexes, such as those of the Achilles tendon, may also be absent. SHA can occur due to a viral infection that causes inflammation and damages neurons.

The loss of deep tendon reflexes is permanent, but SHA is not fatal or severely disabling.

Other types of autonomic dysfunction can result from disease or damage to the body. Autonomic neuropathy refers to damage to the nerves of certain medications, injuries, or diseases. The diseases that cause this neuropathy include:

  • Bacterial infection
  • Long-term drinking
  • Autoimmune disorders
  • Parkinson’s disease causes orthostatic hypotension and other symptoms of ANS damage.


How is autonomic dysfunction treated?

Your doctor will treat autonomic dysfunction by addressing the symptoms. They can treat orthostatic hypotension by suggesting changes in lifestyle and prescribing medications. The symptoms of orthostatic hypotension may respond to:

  1. Raising the head of the bed.
  2. Drink enough fluids.
  3. Wear compression stockings to prevent the accumulation of blood in the legs.
  4. Take medications like midodrine.

Your doctor will also treat the underlying cause, such as alcohol use disorder.