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Delayed Orthostatic Intolerance

Delayed Orthostatic Intolerance Abstract In seven patients who presented with lightheadedness, fatigue, "weakness," and sometimes syncope, blood pressure was found not to fall after standing for 3 to 4 minutes but to fall severely, frequently with syncope or presyncopal symptoms, after 13 to 30 minutes when measured every minute with an automatic device. This delayed orthostatic hypotension could be corrected with inflation of a pressure suit to 45 mm Hg. Its mechanism was further investigated with measurements of plasma catecholamines, plasma cortisol and aldosterone responses to corticotropin, and the effects of norepinephrine infusions on blood pressure and venous contractility. There was normal or excessive orthostatic norepinephrine release in all patients, evidence of impaired venous innervation in the legs in some, and various disorders in the other patients. Since therapeutic improvement in the orthostatic hypotension greatly reduced the symptoms, we concluded that orthostatic hypotension occurring after more than 10 minutes of standing is a potentially debilitating and often correctable disorder. (Arch Intern Med. 1992;152:1066-1072) References 1. Streeten DHP. Orthostatic Disorders of the Circulation . New York, NY: Plenum Publishing Corp; 1987. 2. Watson E. Liquid chromatography with electrochemical detection for plasma norepinephrine and epinephrine . Life Sci. 1981;28:493-497.Crossref 3. Streeten DHP, Anderson GH Jr, Richardson R, Thomas FD. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling . J Lab Clin Med. 1988;111:326-335. 4. Miller JW, Streeten DHP. Vascular responsiveness to norepinephrine in sympathicotonic orthostatic intolerance . J Lab Clin Med. 1990;115:549-558. 5. Streeten DHP. Pathogenesis of hyperadrenergic orthostatic hypotension: evidence of disordered venous innervation exclusively in the lower limbs . J Clin Invest. 1990;86:1582-1588.Crossref 6. Streeten DHP, Anderson GH Jr, Lebowitz M, Speller PJ. Primary hyperepinephrinemia in patients without pheochromocytoma . Arch Intern Med. 1990;150:1528-1533.Crossref 7. Goodfriend TL. Radioimmunoassay of angiotensins and renin activity . In: Berson SA, Yalow RS, eds. Methods in Investigative and Diagnostic Endocrinology . Amsterdam, the Netherlands: North-Holland Publishing Co; 1973:1158-1168. 8. Streeten DHP, Kerr LP, Kerr CB, Prior JC, Dalakos TG. Hyperbrady-kininism: a new orthostatic syndrome . Lancet. 1972;2:1048-1053.Crossref 9. Carney JA, Sizemore GW, Tyce GM. Bilateral adrenal medullary hyperplasia in multiple endocrine neoplasia, type 2: the precursor of bilateral pheochromocytoma . Mayo Clin Proc. 1975;50:3-10. 10. DeLellis RA, Wolfe HJ, Gagel RF, et al. Adrenal medullary hyperplasia: a morphometric analysis in patients with familial medullary thyroid carcinoma . Am J Pathol. 1976;83:177-196. 11. Tohmeh JF, Shah SD, Cryer PE. The pathogenesis of hyperadrenergic postural hypotension in diabetic patients . Am J Med. 1979;67:772-778.Crossref 12. Grubb BP, Temesy-Armos P, Hahn H, Elliott L. Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin . Am J Med. 1991;90:6-10.Crossref 13. Kenny RA, Ingram A, Bayliss J, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope . Lancet. 1986;2:1352-1354.Crossref 14. Sra JS, Anderson AJ, Sheikh SH, Avitall B, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing . Ann Intern Med. 1991;114:1013-1019.Crossref 15. Jones JF, Roy CG, Minnich LL, Hicks MJ, Kibler R, Lucas DO. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies . Ann Intern Med. 1985;102:1-7.Crossref 16. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med. 1985;102:7-16.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1992.00400170138025
Publisher site
See Article on Publisher Site

Abstract

Abstract In seven patients who presented with lightheadedness, fatigue, "weakness," and sometimes syncope, blood pressure was found not to fall after standing for 3 to 4 minutes but to fall severely, frequently with syncope or presyncopal symptoms, after 13 to 30 minutes when measured every minute with an automatic device. This delayed orthostatic hypotension could be corrected with inflation of a pressure suit to 45 mm Hg. Its mechanism was further investigated with measurements of plasma catecholamines, plasma cortisol and aldosterone responses to corticotropin, and the effects of norepinephrine infusions on blood pressure and venous contractility. There was normal or excessive orthostatic norepinephrine release in all patients, evidence of impaired venous innervation in the legs in some, and various disorders in the other patients. Since therapeutic improvement in the orthostatic hypotension greatly reduced the symptoms, we concluded that orthostatic hypotension occurring after more than 10 minutes of standing is a potentially debilitating and often correctable disorder. (Arch Intern Med. 1992;152:1066-1072) References 1. Streeten DHP. Orthostatic Disorders of the Circulation . New York, NY: Plenum Publishing Corp; 1987. 2. Watson E. Liquid chromatography with electrochemical detection for plasma norepinephrine and epinephrine . Life Sci. 1981;28:493-497.Crossref 3. Streeten DHP, Anderson GH Jr, Richardson R, Thomas FD. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling . J Lab Clin Med. 1988;111:326-335. 4. Miller JW, Streeten DHP. Vascular responsiveness to norepinephrine in sympathicotonic orthostatic intolerance . J Lab Clin Med. 1990;115:549-558. 5. Streeten DHP. Pathogenesis of hyperadrenergic orthostatic hypotension: evidence of disordered venous innervation exclusively in the lower limbs . J Clin Invest. 1990;86:1582-1588.Crossref 6. Streeten DHP, Anderson GH Jr, Lebowitz M, Speller PJ. Primary hyperepinephrinemia in patients without pheochromocytoma . Arch Intern Med. 1990;150:1528-1533.Crossref 7. Goodfriend TL. Radioimmunoassay of angiotensins and renin activity . In: Berson SA, Yalow RS, eds. Methods in Investigative and Diagnostic Endocrinology . Amsterdam, the Netherlands: North-Holland Publishing Co; 1973:1158-1168. 8. Streeten DHP, Kerr LP, Kerr CB, Prior JC, Dalakos TG. Hyperbrady-kininism: a new orthostatic syndrome . Lancet. 1972;2:1048-1053.Crossref 9. Carney JA, Sizemore GW, Tyce GM. Bilateral adrenal medullary hyperplasia in multiple endocrine neoplasia, type 2: the precursor of bilateral pheochromocytoma . Mayo Clin Proc. 1975;50:3-10. 10. DeLellis RA, Wolfe HJ, Gagel RF, et al. Adrenal medullary hyperplasia: a morphometric analysis in patients with familial medullary thyroid carcinoma . Am J Pathol. 1976;83:177-196. 11. Tohmeh JF, Shah SD, Cryer PE. The pathogenesis of hyperadrenergic postural hypotension in diabetic patients . Am J Med. 1979;67:772-778.Crossref 12. Grubb BP, Temesy-Armos P, Hahn H, Elliott L. Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin . Am J Med. 1991;90:6-10.Crossref 13. Kenny RA, Ingram A, Bayliss J, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope . Lancet. 1986;2:1352-1354.Crossref 14. Sra JS, Anderson AJ, Sheikh SH, Avitall B, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing . Ann Intern Med. 1991;114:1013-1019.Crossref 15. Jones JF, Roy CG, Minnich LL, Hicks MJ, Kibler R, Lucas DO. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies . Ann Intern Med. 1985;102:1-7.Crossref 16. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med. 1985;102:7-16.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1992

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