Why the study?
Does ergotamine improve symptoms in a patient with severe postural hypotension secondary to diabetic autonomic neuropathy?
Does ergotamine improve symptoms in a patient with severe postural hypotension secondary to diabetic autonomic neuropathy?
Ergotamine may be an effective treatment option for refractory cases of severe postural hypotension secondary to diabetic autonomic neuropathy.
Ergotamine may relieve refractory postural hypotension in diabetic autonomic neuropathy; leaves open confirmation in controlled trials.
BACKGROUND: Symptomatic postural hypotension in diabetes is uncommon. When it does occur, it can prove debilitating and difficult to treat. We report here the therapeutic challenges encountered in managing a patient with severe postural hypotension secondary to diabetes-related autonomic neuropathy. CASE REPORT: A 69-year-old gentleman with a 23-year history of Type 1 diabetes mellitus and multiple microvascular complications was admitted with symptoms of severe postural hypotension. Cardiovascular autonomic testing confirmed the presence of severe autonomic neuropathy. He failed to respond to non-pharmacological measures, fludrocortisone, midodrine, octreotide, erythropoietin and increased caffeine intake. Eventually he was commenced on half a Cafergot suppository (giving him a dose of ergotamine 1 mg and caffeine 50 mg) which resulted in dramatic clinical improvement. CONCLUSION: Ergotamine may be considered in refractory cases of postural hypotension.
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Toh et al. (2006) studied this question.
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