What is paraneoplastic autonomic neuropathy?
Some patients with small-cell lung cancer, pancreatic adenocarcinoma, prostate cancer, or Hodgkin’s lymphoma may develop autonomic symptoms (orthostatic dizziness, impotence, dry mouth, urinary retention, or GI symptoms) with either no or minimal somatic involvement that may improve with treatment of the tumor.
In these patients, the autonomic neuropathy may be part of a generalized paraneoplastic syndrome that variably includes sensory neuronopathy, limbic and brain stem encephalitis, cerebellar degeneration, and a sensorimotor neuropathy.
Approximately 40% of patients have antibodies directed against the nicotinic ACh receptors in the autonomic ganglia.
The list of antibodies in paraneoplastic autonomic neuropathies has been constantly expanding and includes antineuronal nuclear antibodies, Purkinje cell cytoplasmic autoantibody (PCA), and collapsin response-mediated protein 5 (CRMP-5).
The presentation of autonomic neuropathy may either precede or follow the diagnosis of malignancy.
