Orthostatic Hypotension Associated with Pernicious Anemia

Abstract

POSTURAL HYPOTENSION, first described by Bradbuiy and Eggleston in 1925, ' has been well documented in a variety of systemic diseases affecting the central nervous system such as tabes dorsalis 2 and diabetes mellitus.3 The syndrome is characterized by orthostatic hypotension, a rela¬ tively fixed pulse rate (except with diabetes melli¬ tus when it may be variable), and hypohidrosis. The following case report is of interest because it represents a well-documented case of orthostatic hypotension with pernicious anemia, and there was a complete remission following treatment with Cyanocobalamin ( vitamin B12 ) and folie acid. Report of a CaseA 66-year-old retired government employee was admitted to the Oklahoma City Veterans Administration Hospital in September, 1959, complaining of weakness and light-headed spells. His symptoms had begun 3 years previously but had subsided after several months of therapy which re¬ putedly consisted of iron and liver. One year before ad¬ mission, his symptoms had recurred, with associated anorexia, for 5 months, resulting in a 30-lb. ( 13.6 kg. ) weight loss. He gave no history of frank syncope, but dizziness was more pronounced upon standing up suddenly. There had been slight numbness and tingling of the fingers and toes for several months. All symptoms diminished somewhat after taking a bottle of a patent multivitamin preparation which contained both vitamin Bu¡ and folie acid. His systemic review indicated a decrease in sweating for several years. He had been impotent for 3 or 4 years and had nocturia 3 or 4 times nightly for several months. His only past illness of consequence had occurred in 1936, when he was hospitalized for what was thought to be pellagra.On physical examination, the blood pressure was 104 mm. Hg systolic, and 60 diastolic, taken in a sitting posi¬ tion. The pulse rate was 72 beats per minute. The patient appeared elderly and somewhat pale, but not acutely ill. The mucous membranes were pale and the tongue was smooth but otherwise unremarkable. The skin was dry and only mild perspiration was evident in the axillae. A few rhonchi were present over the lower left lung. A faint sys¬ tolic murmur was audible along the left sternal border. The prostate was slightly enlarged. Deep tendon reflexes were normally active. Vibratory sensation was absent below the hips and position sense was moderately impaired.The initial laboratory studies were as follows: Several urinalyses showed repeatedly low specific gravities, the highest being 1.016, and a trace of albumin. There were 2 to 4 leukocytes per high-power field and a few bacteria in the sediment. Several urine cultures grew Aerobacter aerogenes. A serological test for syphilis, utilizing the cardiolipin microflocculation method, was nonreactive. Blood urea nitrogen was 11 mg.%, sulfobromophthalein retention was 13% in 45 minutes. Total serum proteins were 4.8 gm.%, with 3.3 gm.% of albumin and 1.5 gm.% of globulin. Serum transaminase, alkaline phosphatase, and bilirubin were normal. Stools were repeatedly negative f...