Urinary 6-hydroxymelatonin excretion in patients with orthostatic hypotension.

The rates of melatonin formation and its diurnal fluctuations have been examined in patients with three types of orthostatic hypotension by measuring the urinary excretion rates of 6-hydroxymelatonin, the major metabolite of the pineal gland hormone. Deficiencies in the peripheral autonomic nervous system resulted in markedly diminished daily excretion (2.5 +/- 1.3 micrograms) relative to control (12.2 +/- 1.2). Patients with impaired central nervous system function exhibited low and/or abnormal excretion patterns. Two patients with sympathotonic orthostatic hypotension excreted greater amounts of 6-hydroxymelatonin than any of the control subjects. Melatonin secretion by the pineal gland can be used as an index of sympathetic nerve function. The study of patients with altered function may reveal the role of the pineal gland in human physiology.