Octreotide for orthostatic hypotension.

A patient suffering from multiple system atrophy (Shy-Drager syndrome) with severe symptomatic postprandial orthostatic hypotension was treated. Because the disease was progressively refractory to fludrocortisone and midodrine, octreotide was introduced subcutaneously (25 micrograms before meals). Beneficial effects were clearly noted by the patient and documented by repeated tilt table testing with and without the octreotide. The literature on the physiological actions of octreotide and the clinical evidence supporting its use are reviewed briefly. Octreotide mainly mediates splanchnic venoconstriction, which explains its beneficial effects. It is a useful adjunct for the short term treatment of orthostatic hypotension associated with dysautonomia. Its long term efficacy and safety need to be studied.