Orthostatic hypotension, anhidrosis, and impotence.

Anhidrosis and impotence occur frequently with idiopathic orthostatic hypotension. Two new cases of this syndrome, which occurs chiefly in males over 40 years of age, are herewith described. Postural vertigo and/or syncope, weakness, and anhidrosis or hypohidrosis are common symptoms, and a marked fall in systolic and diastolic blood pressure is noted when the patients stand. The patho-logic physiology of the syndrome is discussed and various forms of therapy, none of them especially satisfactory, are reviewed. IN 1925 Bradbury and Eggleston' reported the occurrence of a hitherto unrecognized clinical phenomenon, orthostatic hypo-tension, which they observed in three males, all of whom sustained a fall in systolic and diastolic blood pressure when they assumed upright posture. Their patients also exhibited a slow, unchanging pulse rate, dizziness, syn-cope, and anhidrosis or hypohidrosis. Subsequently , many instances of postural or ortho-static hypotension have been reported. In general, two types may be defined: (1) those due to known cause, among which are sym-pathectomy,2 tabes dorsalis,3-'0 diabetes mel-litus,3 11 myasthenia gravis,12 Addison's disease 7, 13, 14 hypopituitarism,"5 syringomyelia and hematomyelia3; and (2) those due to unknown or ill-defined disease of the central nervous system. In the latter group of patients a wide spectrum of signs and symptoms has been observed, but the findings in some of the patients cannot be considered to conform to the clinical syndrome originally described by Bradbury and Eggleston. For purposes of this study arbitrary criteria have been established to emphasize the concomitant occurrence of postural hypotension, anhidrosis and impotence a triad to which attention was first called by East and Brigden.'6 Only those cases, therefore, manifesting significant systolic and diastolic postural hypotension, * with an unchanging or only slightly increased pulse rate, and anhidro-sis or hypohidrosis have been included. With the two cases which we have observed and which are herein described, a total of 37 cases"1 4, 5, 16-41 has been gathered from the literature. 182971),t a 65 year old white married painter, was admitted to the Barnes Hospital for the first time on April 1, 1950, for study of "low blood pressure." His chief complaints were dizziness and lightheadedness of two years' duration. Three years before entry he noted that he ceased sweating on the left side, and one year before entry he stopped perspiring on the right side. Two years before admission he also began to feel "light-headed" whenever he stood up. Concomitantly dizziness appeared when he …