The symptoms of DAN are often very subtle and insidious in onset and may be unrecognized. Alternatively, because the symptoms of DAN can be so diverse and reproduce the appearance of many other disease processes, the patient may be subjected to extensive diagnostic evaluation without reward. In common with other forms of diabetic neuropathy, DAN is essentially a diagnosis of exclusion. The most prominent clinical signs and symptoms of autonomic involvement complicating diabetes include the gastrointestinal tract system, cardiovascular system, bladder, sex organs, ocular pupil, sweat glands, and adrenal medullary system. The clinical presentations of this multiple-organ involvement are discussed in the following sections.
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