Ambulatory infusion of noradrenaline for long-term treatment of Shy-Drager syndrome.
A 70-year-old female patient with advanced Shy-Drager syndrome exhibited severe orthostatic hypotension, low serum catecholamine levels, and autonomic dysfunction. She was bedridden despite oral medication with fludrocortisone, etilefrin, dihydroergotamine, L-dopa, yohimbine, and amezinium methyl sulfate. Only intravenous application of noradrenaline (30 ng/kg/min) provided complete mobilization. After implantation of a port-a-cath system, intravenous noradrenaline treatment could be continued on an outpatient basis. Over the following 5 years, the patient was throughout sufficiently mobile and did not show any significant side effects of this treatment. However, during the 5th year she suffered from nonhemorrhagic brain stem infarction due to cerebral hypoperfusion after orthostatic stress in the absence of noradrenaline infusion. We conclude that ambulatory noradrenaline infusion is a new valuable tool for long-term treatment of advanced Shy-Drager syndrome.
Kribben
A
A
Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum Essen, Deutschland.
Bremer
C
C
Fritschka
E
E
Koeppen
S
S
Ahrens
O
O
Philipp
T
T
D000553:Ambulatory Care; D001794:Blood Pressure / Q000187:drug effects; D002544:Cerebral Infarction / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007262:Infusions, Intravenous; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D012008:Recurrence; D012791:Shy-Drager Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D009638:Norepinephrine