What is your preferred workup for patients who present with concern for autonomic neuropathy?

1. When patients report one or more symptoms suggestive of autonomic dysfunction, objective confirmation of impaired autonomic function is required. This may include the standard battery of autonomic tests included in the CASS score (tilt table testing, response of HR and BP to Valsalva maneuver, and QSART) or additional tests depending on the symptom (eg gastric motility studies, urodynamic studies, colon transit time, etc). It should be reminded that positive review for autonomic symptoms is com...

Agreed - excellent answer. And I want to heartily second the notion that ANS *symptoms* are not evidence of actual ANS dysfunction. Trust patient reports, but verify the etiology.

Would add only that, in the context of results for ANS testing, abnormal submotor function results could be followed up with skin biopsy to look for evidence of small fiber neuropathy as well. In the absence of an abnormal EMG/NCS, this can, at times, help narrow the differential/guide further testing.