Autonomic Disorders We Assess
If your symptoms suggest a problem with how your body's automatic systems are working — blood pressure regulation, heart rate, sweating, digestion — this is the kind of work we do.
You do not need a referral from your doctor. Request an appointment online in about two minutes, and we will call you to arrange a time. Testing takes 40–60 minutes.
Request an appointment →Please note the tests themselves are not covered by a Medicare rebate. Questions? Call 02 9388 0615.
The autonomic nervous system runs the body's background processes — blood pressure, heart rate, sweating, gut motility, pupil size. When it doesn't work properly the symptoms often cross specialty lines, which is why testing helps clarify what's actually going on. These are the conditions most commonly referred to us.
Postural Tachycardia Syndrome (POTS)
The most common form of dysautonomia
POTS is characterised by an excessive rise in heart rate on standing, with symptoms of orthostatic intolerance — lightheadedness, palpitations, brain fog, fatigue. It is most common in women aged 15–50 and frequently follows a viral illness or surgery. Quantitative testing supports the diagnosis, distinguishes POTS from orthostatic hypotension and inappropriate sinus tachycardia, and helps guide treatment (which combines volume expansion, salt loading, graded exercise, and selected medications).
POTS Testing Sydney →Orthostatic Hypotension
When standing can't be explained
Orthostatic hypotension is a sustained drop in blood pressure on standing, causing dizziness, weakness or lightheadedness. Autonomic testing distinguishes orthostatic hypotension, autonomic failure and POTS — conditions whose treatments are very different. The active stand test with recovery blood pressure characterises each pattern objectively.
How the test works →Small Fibre Neuropathy (SFN)
Burning feet, autonomic features, unexplained pain
Small fibre neuropathy affects the tiny nerve fibres that carry pain and temperature signals and that supply autonomic functions (sweating, blood pressure regulation, gut motility). Symptoms include burning or stinging feet, sensitivity to bedclothes, abnormal sweating, and orthostatic intolerance. Standard nerve conduction studies are usually normal in SFN. Skin biopsy with intraepidermal nerve fibre density (IENFD) remains the gold standard for diagnosis; autonomic testing (especially SudoScan) detects autonomic-fibre involvement and helps build the case for biopsy.
SFN deep-dive →Diabetic Autonomic Neuropathy
A common but under-recognised diabetic complication
Diabetes can damage the small autonomic nerve fibres years before more obvious complications appear. The autonomic features include resting tachycardia, exercise intolerance, postural hypotension, gastroparesis, abnormal sweating, and erectile dysfunction. SudoScan plus the full autonomic protocol provides a quantitative baseline that is useful for both diagnosis and tracking progression alongside glycaemic management.
How the test works →Post-Viral & Long-COVID Dysautonomia
When dysautonomia follows a viral illness
A subset of patients develop POTS-like or other autonomic symptoms following viral infections, including COVID-19, Epstein-Barr virus, and influenza. The clinical picture is dominated by orthostatic intolerance, palpitations, exercise intolerance, and brain fog. Autonomic testing characterises the physiological pattern objectively, which both validates the diagnosis and guides graded recovery strategies. It also distinguishes autonomic causes from deconditioning, where management is different.
How the test works →Multiple System Atrophy & Parkinsonian Autonomic Failure
When autonomic involvement supports the diagnosis
Parkinson's disease and related synucleinopathies (Multiple System Atrophy, Dementia with Lewy Bodies, Pure Autonomic Failure) typically have significant autonomic involvement — orthostatic hypotension, urinary symptoms, constipation, sweating abnormalities. Demonstrating widespread autonomic failure on quantitative testing supports MSA over Parkinson's disease in atypical presentations and informs management and prognosis. It also helps guide medication choices, since some Parkinson's treatments can worsen autonomic symptoms.
How the test works →Autoimmune Autonomic Ganglionopathy (AAG)
An immune-mediated, often treatable cause
Autoimmune autonomic ganglionopathy is an uncommon but important cause of dysautonomia, in which antibodies attack the ganglionic acetylcholine receptor. It can present subacutely with widespread autonomic failure, gastrointestinal dysmotility, anhidrosis and orthostatic hypotension. Recognition matters because it can respond to immune therapy. Autonomic testing characterises the pattern of failure and supports the case for antibody testing and targeted treatment.
How the test works →None of these conditions are diagnosed by autonomic testing alone. Testing characterises the autonomic involvement and patterns; final diagnosis combines those findings with the clinical history, blood tests, imaging, and (where relevant) skin biopsy or antibody studies. Your specialist puts the picture together.
Frequently Asked Questions
Can one test rule in or rule out all of these conditions?
No single test does that. Autonomic function testing characterises which autonomic domains are affected and how severely — that pattern, combined with the clinical history and other investigations, supports or refines the diagnosis. For some conditions (such as small fibre neuropathy) skin biopsy remains the gold standard; for others (such as autoimmune autonomic ganglionopathy) antibody testing is also needed.
Which of these conditions can be treated?
All of them benefit from accurate characterisation, and most have specific management options. POTS, orthostatic hypotension, and post-viral dysautonomia respond well to combined lifestyle and pharmacological approaches. Diabetic autonomic neuropathy is managed alongside glycaemic control. Autoimmune causes (such as AAG) may respond to immune therapy. Your specialist will discuss the treatment options most relevant to your diagnosis.
How is testing here different from being referred to a public autonomic unit?
The equipment and protocol are equivalent to a public hospital autonomic unit. The difference is access — patients are typically seen within 1–2 weeks rather than waiting 6–12 months — and the report is issued within a week of testing.
Do I need a referral to be seen here?
No — a referral is not required for autonomic testing. Your GP's details are helpful, though, so we can send a copy of your report to your doctor. Contact us and we will arrange an appointment.
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