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Autoimmune Dysautonomia Evaluation

An Update

Published: July 2012

Hot Topic Q&A is an opportunity for viewers to submit questions to the Hot Topic presenter. The opportunity to submit questions for this topic is now closed.

The following questions were submitted by viewers and answered by the presenter, Andrew McKeon, MB, BCh, MD, consultant in the Neuroimmunology Laboratory in the Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota. 

Questions are presented as submitted (unedited).

  1. Is this testing appropriate for patients that present with cardiac symptoms suggestive of dysautonomia?

    Patients with dysautonomia limited to orthostatic hypotension, or orthostatic tachycardia may have an autoimmune diagnosis, but (obviously) structural cardiac causes need to be excluded also.

  2. Are there other autoimmune conditions, besides those discussed in the presentation, that can cause dysautonomia? Are there other tests that can be done to objectively confirm or rule-out these conditions as well?

    Autoimmune dysautonomia can coexist with other autoimmune diseases, such as type 1 DM, hypothyroidism, lupus etc. The testing described is appropriate for those patients also.

  3. Is small-cell carcinoma always the result of the tested in this presentation or is the 50% that responded to medication have a likelihood of diagnoses? If so, could this be a generated test performed at all hospitals?

    Some antibodies have a very high positive predictive value for small-cell carcinoma (such as ANNA-1, 70% to 90% positive predictive value). Other antibodies have a lower predictive value for cancer and are associated with more diverse cancer types (eg, VGKC complex antibodies have a 20% to 30% positive predictive value for cancer, including adenocarcinomas, hematological malignancies as well as small-cell carcinoma).