orthostatic hypotension in Parkinson's disease

Etiology: - multifactorial - L-dopa & dopamine agonists contribute Pathology: - involves degeneration of the a) hypothalamus b) intermediolateral column of spinal cord c) peripheral sympathetic nerves Clinical manifestations: - generally occurs in patients with advanced Parkinson's disease Differential diagnosis: - if it occurs early, consider Parkinson plus syndrome Management: 1) reduce antihypertensive agents 2) exchange terazosin for tamsulosin in patients with BPH 3) liberalize salt intake 4) fludrocortisone (Florinef) a) if other measures fail b) 0.1 mg QD generally adequate 5) midodrine in moderate-severe cases - may be added to low-dose Florinef

References

Bronstein J, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004