Acquired forms of autonomic neuropathy may be isolated or may coexist with somatic neuropathy. Clinical identification of symptoms and signs in the patient with autonomic dysfunction is crucial in the diagnosis of autonomic neuropathy and its separation from pure autonomic failure or multiple system atrophy. Once an autonomic neuropathy has been identified, several clinical features can be useful in the diagnosis of a specific form of autonomic neuropathy. Other factors, such as the presence of somatic neuropathy and systemic disease, are critical for diagnosis. This article reviews the clinical presentation, diagnosis, pathogenesis, and management of the acquired forms of autonomic neuropathy.