Postural Hypotension

Postural, or better, orthostatic, hypotension was first described in 1925 by Bradbury and Eggleston.The outstanding symptom, a profound fall in blood pressure on standing up, is one of a triad.The other two, less dramatic, but none the less important and almost constantly present, are anhydrosis and impotence.The disease is almost entirely confined to males, and only two out of twenty-four reported cases have been women.The age at which symptoms are first noted has been anything from 28 to 70 years.Accounts of the first appearance of symptoms are not always full, but it is clear that in a fair proportion the first indication of the onset of the disease is anhydrosis; this has sometimes been there for a number of years before the symptoms of hypotension have attracted attention.Impotence appears to come later; usually with or after the hypotension. REPORT OF A CASEThe following is an account of the investigation of a case which presented characteristic features.J. M. was an engineer, aged 57, married, with four children.He had a severe attack of typhoid at 45; at 49 he suffered from metal poisoning: his occupation at that time led him to handle brass, gun metal, and phosphor-bronze, and sometimes he put a valve of this material in his mouth.Up to the age of 55 he still played tennis.He had felt the cold of recent years.Syncopal attacks.At the age of 50 he began to suffer from what he called fainting attacks, which came on when he was standing up, never when sitting or lying.Before the attack he used to feel giddy and unsteady; his legs trembled and his hands began to shake, and he could no longer stand up; and he had to drop straight down and sit crouched or leaning forward holding his head down, semi-conscious.Sometimes he lost consciousness.The attack lasted several minutes; after a little he would recover and could go on walking.During the last few years the attacks had become more frequent.Apart from the giddiness, the attacks were not particularly unpleasanit; there was no nausea, nor sinking feeling in the abdomen, nor sweating.Usually the attacks were more frequent in the morning than in the afternoon.Anhydrosis.He had never sweated on his face and for the last four years has not sweated at all.For many years he only sweated on the left side of his body.This had been noted by his fellow workers, for only one side of his shirt became damp.Impotence.About the age of 37 he became impotent and has had no sexual activity or desire since.He was never constipated.This account is fairly characteristic of this disorder, and the observations on the blood pressure given below confirm the diagnosis.Physical examination.A small thin man, rather bent, looking rather younger than his years.Height, 5 feet 2 inches, weight 8 stone 4 pounds.His demeanour was alert and active.His skin was inelastic and dry, with a greyish pallor.