Postural Hypotension and Anhidrosis

influence nerve growth factor synthesis in primary rat astrocytes. Heterogeneous cardiac sympathetic denervation and decreased myocardial nerve growth factor in streptozotocin diabetic rats: implications for cardiac sympathetic dysinnervation complicating diabetes. Stimulation of nerve growth factor synthesis/ secretion in mouse astroglial cells by coenzymes. A fluorescence-based method for measuring total plasma antioxidant capability. Evaluation of aldose reductase inhibitior on nerve blood flow, conduction, metabolism, and antioxidant defense in streptozotocin-diabetic rats: an intervention study. Effects of treatment with the antioxidant α-lipoic acid on cardiac autonomic neuropathy in NIDDM patients. A 4-month randomized controlled multicenter trial (DEKAN study). The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The Sydney trial. SUMMARY Orthostatic hypotension (OH) occurs in 10–20% of patients seen in diabetic practice. Patients can be asymptomatic or manifest symptoms of cerebral hypoperfusion, such as lightheadedness or weakness, or less common symptoms of sympathetic overactivity. Syncope can occur. Symptoms correlate with autonomic deficits. Autonomic laboratory evaluation demonstrates early impairment of cardiovagal and distal postganglionic sudomotor function, eventually leading to generalized autonomic failure. Treatment of OH consists nonpharmacological and pharmacological therapy. The former involves patient education, management of salt, fluids, sleeping with head of the bed elevated, compression garments, and physical countermaneuvers. Pharmacological therapy with midodrine is efficacious but aggravates supine hypertension. Pyridostigmine will improve OH without aggravating supine hypertension although its effects are the modest. Sudomotor failure is the rule, manifests initially as distal anhidrosis followed by regional, multifocal, and other patterns of sweat loss. Sudomotor symptoms include regional hyperhidrosis and heat intolerance.