The most common causes of autonomic insufficiency are Diabetes (most common) Peripheral neuropathies Aging Parkinson disease Other causes include Autoimmune autonomic neuropathy Multiple system atrophy Pure autonomic failure Spinal cord disorders Certain drugs Disorders of the neuromuscular junction (eg, botulism, Lambert-Eaton syndrome) Certain viral infections, possibly including COVID-19 Injury to nerves in the neck, including that due to surgery Autonomic insufficiency that occurs with COVID-19 typically develops after recovery from the respiratory and other acute systemic symptoms of COVID.