orthostatic hypotension in Parkinson's disease

Etiology

• multifactorial
  • L-dopa & dopamine agonists contribute

Pathology

• involves degeneration of the
  • hypothalamus
  • intermediolateral column of spinal cord
  • 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

• reduce antihypertensive agents
• exchange terazosin for tamsulosin in patients with BPH
• liberalize salt intake
• fludrocortisone (Florinef)
  • if other measures fail
  • 0.1 mg QD generally adequate
• midodrine in moderate-severe cases
  • may be added to low-dose Florinef

More general terms

• orthostatic hypotension