Document 0025
 DOCN  M9460025
 TI    [Etiological aspects of orthostatic hypotension]
 DT    9408
 AU    Bletry O; Service de Medecine Interne, Hopital de la Pitie, Paris.
 SO    Rev Med Interne. 1992 Nov;13(6):430-7. Unique Identifier : AIDSLINE
       MED/94225091
 AB    Orthostatic hypotension (OH) must be distinguished from supine
       hypotension made worse by standing up and, in particular, from vasovagal
       syncope. At first approximation, asympathicotonic invariable pulse OH
       virtually always related to an organic lesion of the baroreflex arch
       must be distinguished from variable pulse OH which is usually functional
       and may also be due to organic lesions with exclusive or predominant
       sympathetic system disorders. In case of doubt, it may be useful to
       measure palmar and plantar sympathetic potentials. The principal causes
       of variable pulse OH are therapeutic drugs, absolute or relative
       hypovolaemia, endocrine diseases (adrenal insufficiency,
       phaeochromocytoma), spinal quadriplegia and two congenital diseases
       including dopamine beta-hydroxylase deficiency. In Guillain-Barre
       syndrome, diabetes and alcoholism, the OH pulse may be variable or
       invariable. The main causes of asympathicotonic OH are ageing,
       post-prandial period, certain infections (e.g. tabetic neurosyphilis,
       botulism, EBV and HIV infections), a few systemic diseases and isolated
       neurological diseases. Among the systemic diseases responsible for OH
       are diabetes, alcoholism and chronic liver diseases of other causes,
       porphyria, lead poisoning, Biermer's disease, amyloidosis, several
       connective tissue diseases, including systemic lupus erythematosus, and
       some cancers associated or not with Lambert-Eaton syndrome. Among
       isolated neurological diseases are the familial diseases described by
       Riley and Day, multisystem atrophies (first described by Shy and Dager)
       and pure peripheral dysautonomia. To differentiate the latter from an
       incipient Shy-Dager syndrome, it may be helpful to use pharmacological
       tests: plasma catecholamine levels measurements in supine position, and
       clonidine test with repeated growth hormone assays in upright position.
 DE    Blood Pressure Determination  Catecholamines/BLOOD  Clinical Protocols
       Clonidine/DIAGNOSTIC USE  Decision Trees  Diagnosis, Differential
       English Abstract  Human  Hypotension,
       Orthostatic/CLASSIFICATION/*DIAGNOSIS/*ETIOLOGY/  PHYSIOPATHOLOGY
       Supine Position  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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