Reversible Orthostatic Hypotension of Pernicious Anemia

IN 1980, White et al¹published a case report that suggested that pernicious anemia could induce a reversible state of orthostatic hypotension, in the absence of other neuropathic signs. This index case was embraced as proved, and incorporated into texts and medical references,²despite the following limitations: (1) the observation was never confirmed by other observers, (2) the period of follow-up was only two months and did not preclude the possibility of relapse or fluctuation of signs and symptoms, and (3) the case history included findings that some argue reflect the presence, albeit subtle, of concomitant peripheral neuropathy. In the same year a patient was seen in our facility with orthostatic hypertension. The clinical course of this patient confirms the relationship proposed by White et al and strengthens their observation by demonstrating reproducibility of the phenomenon and the subsequent persistence of remission after appropriate therapy for 24 months.