title: Ergotamine use in severe diabetic autonomic neuropathy.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Ergotamine may be considered in refractory cases of postural hypotension.
authors: Oxford Centre of Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK. vivien.toh@orh.nhs.uk
authors: V
authors: V
authors: Toh
authors: E
authors: E
authors: Duncan
authors: N
authors: N
authors: Lewis
authors: L
authors: L
authors: Fichter
authors: D R
authors: DR
authors: Matthews