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Lamotte G, Takahashi M, Wu T, Sullivan P, Cherup J, Holmes C, Goldstein DS. Do indices of baroreflex failure and peripheral noradrenergic deficiency predict the magnitude of orthostatic hypotension in Lewy body diseases? Clin Auton Res 2021; 31:543-551. [PMID: 33710459 DOI: 10.1007/s10286-021-00788-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/10/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patients with neurogenic orthostatic hypotension in the setting of Lewy body diseases (LBnOH) typically have baroreflex failure and peripheral noradrenergic deficiency. Either or both of these abnormalities might determine the magnitude of OH in individual patients. We retrospectively correlated the orthostatic fall in systolic blood pressure (∆BPs) during active standing or 5 min of head-up tilt at 90° from horizontal as a function of several baroreflex and sympathetic noradrenergic indices. METHODS Physiological, neurochemical, and sympathetic neuroimaging data from the Valsalva maneuver, head-up tilt table testing, and thoracic 18F-dopamine positron emission tomographic scanning (18F-DA PET) were analyzed from 72 patients with LBnOH [44 with Parkinson disease (PD) and nOH, 28 with pure autonomic failure]. Comparison subjects had PD without OH (N = 44) or PD risk factors without parkinsonism or OH (N = 28) or were healthy volunteers (N = 8). Indices of baroreflex function included the Valsalva maneuver-associated baroreflex areas in Phase II (BRA-II) and IV (BRA-IV), the pressure recovery time (PRT), and baroreflex-cardiovagal and adrenergic sensitivities (BRS-V and BRS-A). The fractional orthostatic increment in plasma norepinephrine (Fx∆NE) provided a neurochemical index of baroreflex-sympathoneural function. RESULTS As expected, the LBnOH group had baroreflex-sympathoneural and baroreflex-cardiovagal impairment and low cardiac 18F-DA-derived radioactivity. Among patients, values for ∆BPs correlated with BRA-II, BRA-IV, BRS-V, and Fx∆NE but not with values for PRT, BRS-A, supine plasma NE, or 18F-DA-derived radioactivity. CONCLUSION Across individual patients with LBnOH, quantitative indices of baroreflex dysfunctions and peripheral noradrenergic deficiency are inconsistently associated with the magnitude of OH, even under controlled laboratory conditions.
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Affiliation(s)
- Guillaume Lamotte
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Makoto Takahashi
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Tianxia Wu
- Clinical Trials Unit, NINDS, NIH, Bethesda, MD, USA
| | - Patricia Sullivan
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA
| | - Jamie Cherup
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA
| | - Courtney Holmes
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA
| | - David S Goldstein
- Autonomic Medicine Section, National Institute of Neurological, Disorders and Stroke (NINDS), National Institutes of Health (NIH), 9000 Rockville Pike 10/8C260, Bethesda, MD, 20892, USA
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Bickel A, Axelrod FB, Schmelz M, Marthol H, Hilz MJ. Dermal microdialysis provides evidence for hypersensitivity to noradrenaline in patients with familial dysautonomia. J Neurol Neurosurg Psychiatry 2002; 73:299-302. [PMID: 12185162 PMCID: PMC1738047 DOI: 10.1136/jnnp.73.3.299] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To use the technique of dermal microdialysis to examine sensitivity of skin vessels to noradrenaline (NA) in patients with familial dysautonomia (FD) and in healthy controls. METHODS In 14 patients with FD and 12 healthy controls, plasma extravasation, local laser Doppler blood flow, and skin blanching were observed before, during, and after application of 10(-6) M NA through a microdialysis membrane, located intradermally in the skin of the lower leg. RESULTS Maximum local vasoconstriction measured by laser Doppler blood flow did not differ between patients with FD and controls. In contrast, patients with FD had an earlier onset of vasoconstriction (p = 0.02). Moreover, reaction to NA was more prominent and prolonged in FD, shown by a larger zone of skin blanching around the microdialysis membrane (p < 0.001) and delayed reduction of the protein content in the dialysate after termination of NA application (p = 0.03). CONCLUSION These data support the hypothesis that peripheral blood vessels of patients with FD show a denervation hypersensitivity to catecholamines. This may be one mechanism contributing to the major hypertension that frequently occurs during "dysautonomic crises" in FD.
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Affiliation(s)
- A Bickel
- Neurologische Klinik, Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Abstract
Primary osteoporosis associated with menopause and aging is by far the most frequent metabolic bone disease. However, there are many patients who present with secondary osteoporosis due to identifiable causal factors and many others in whom a secondary factor contributes to the severity or progression of primary osteoporosis. Recognition of these secondary causes is particularly important for the prevention of further vertebral fractures, which are often progressive in secondary osteoporosis. This review will summarize the major factors that cause secondary osteoporosis and will discuss their pathogenetic mechanisms. While the most frequent cause is glucocorticoid excess, a number of other diseases, as well as drugs and nutritional deficiencies, can cause secondary osteoporosis. It is important to identify secondary osteoporosis both because of the differences in clinical expression due to different pathogenetic mechanisms and because there are often effective interventions that can add to the more general approach used in primary osteoporosis.
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Affiliation(s)
- Z C Orlic
- Department of Endocrinology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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