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Diabetic autonomic neuropathy — SCE Endocrinology MCQ

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ModerateDiabetesDiabetic autonomic neuropathySCE Endocrinology

A 72-year-old man with type 2 diabetes has postural dizziness, early satiety and alternating diarrhoea and constipation. Lying blood pressure is 148/82 mmHg and standing blood pressure after 3 minutes is 106/64 mmHg. ECG shows sinus rhythm and HbA1c is 61 mmol/mol. What is the most likely diagnosis?

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Correct answer: B — Diabetic autonomic neuropathy

Orthostatic hypotension plus gastrointestinal dysmotility in long-standing diabetes supports autonomic neuropathy. Addison's disease can cause postural symptoms but would not explain this pattern as well without pigmentation, hyponatraemia or hyperkalaemia. The pearl is that autonomic neuropathy often spans cardiovascular, gastrointestinal and genitourinary systems.

Reference: NICE NG28, BNF