Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Catecholaminergic storm and extreme blood pressure lability induced by combined levodopa/benserazide, selegiline, and piribedil in Parkinson's disease: a case report.
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Huang Yuhan, Zhao Xingguo, Zhang Xiaowen, Huang Hong, Shen Shanmei, Ji Cheng
Аннотация
BACKGROUND: Cardiovascular autonomic dysfunction was frequently observed in patients with Parkinson's disease (PD), and severe blood pressure (BP) fluctuations posing significant clinical challenges. Although current dopaminergic drugs, (e.g. levodopa/benserazide, selegiline, and piribedil) could improve motor symptoms, the underlying mechanisms of catecholamine storm triggered by concomitant use remained to be fully elucidated.
CASE PRESENTATION: A 62-year-old female with PD was admitted in May 2025 due to abnormal BP fluctuations accompanied by fatigue lasting 20 days. In 2021, she was diagnosed with PD and received long-term treatment with levodopa/benserazide (125 mg tid), selegiline (2.5 mg tid), and piribedil (50 mg tid). Systolic blood pressure (SBP) measured in the hospital varied from 57 to 217 mmHg. A 24-hour peak urinary dopamine level of 36,733 µg/24 h was documented. Multidisciplinary consultation led to discontinuation of selegiline and piribedil while levodopa/benserazide was maintained. Within 72 h, her urinary dopamine levels decreased by 77% (to 8,424 µg/24 h), and standard deviation of BP was reduced from 29.59 to 9.95 mmHg-a 66% decrease. During 3-month follow-up period, the patient's home monitored SBP remained stable between 110 and 135 mmHg although her motor symptoms have advanced manifesting as ipsilateral limb tremors and increased muscle tone.
CONCLUSIONS: This case demonstrated that combined dopaminergic therapy could induce catecholamine storm via synergistic effects, leading to life-threatening fluctuations in BP. Timely identification and adjustment of treatment regimens could effectively reverse cardiovascular risk. However, it was crucial to carefully consider the balance between the progression of motor symptoms and changes in medication treatment.
CASE PRESENTATION: A 62-year-old female with PD was admitted in May 2025 due to abnormal BP fluctuations accompanied by fatigue lasting 20 days. In 2021, she was diagnosed with PD and received long-term treatment with levodopa/benserazide (125 mg tid), selegiline (2.5 mg tid), and piribedil (50 mg tid). Systolic blood pressure (SBP) measured in the hospital varied from 57 to 217 mmHg. A 24-hour peak urinary dopamine level of 36,733 µg/24 h was documented. Multidisciplinary consultation led to discontinuation of selegiline and piribedil while levodopa/benserazide was maintained. Within 72 h, her urinary dopamine levels decreased by 77% (to 8,424 µg/24 h), and standard deviation of BP was reduced from 29.59 to 9.95 mmHg-a 66% decrease. During 3-month follow-up period, the patient's home monitored SBP remained stable between 110 and 135 mmHg although her motor symptoms have advanced manifesting as ipsilateral limb tremors and increased muscle tone.
CONCLUSIONS: This case demonstrated that combined dopaminergic therapy could induce catecholamine storm via synergistic effects, leading to life-threatening fluctuations in BP. Timely identification and adjustment of treatment regimens could effectively reverse cardiovascular risk. However, it was crucial to carefully consider the balance between the progression of motor symptoms and changes in medication treatment.