ERECTILE IMPOTENCE AS A SENTINEL SYMPTOM FOR CARDIOVASCULAR AUTONOMIC NEUROPATHY IN HEAVY-DRINKERS Ravaglia

Since autonomic neuropathy (AN) is not routinely assessed in chronic alcoholism, its features and relationship with other disease parameters remain undefined. The very existence of true alcohol-related autonomic dysfunction, in the absence of alcoholic hepatopathy, is even controversial. We aimed this study at evaluating the frequency and pattern of AN in a population of heavy-drinkers without liver dysfunction; we also investigated the putative risk factors for autonomic neuropathy as well as its relationship with peripheral somatic neuropathy (PN). Autonomic function was evaluated in 70 detoxified alcoholics and 70 well-matched controls by heartrate response to deep breathing, heart rate response to standing from lying position, and blood pressure response to standing-up. PN was assessed by electroneurography. Detailed information about sensorimotor and autonomic symptoms, nutritional status, and parameters reflecting alcohol intake were recorded. No patients showed signs of caloric/protein malnutrition. PN was found in 74% and AN (abnormal test results in 2/3 tests performed) in 26%; abnormalities in at least one autonomic test were found in 62%. All patients with PN were symptomatic, mainly due to sensory disturbances. In line with this, ENG abnormalities were more evident at sural nerves. AN was symptomatic in 10/18 patients, and its sole clinical expression was impotence: indeed, the pattern of autonomic involvement was mainly parasympathetic. AN did not correlate with PN, nor with any parameter reflecting the amount of alcohol intake; only performances on heart rate response to standing from lying position were related to duration of abuse. The lack of correlation between PN and AN may suggest a different pathophysiology for these two complications. Unlike PN, AN is often asymptomatic; among symptomatic patients (55%) erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.