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Ergotamine use in severe diabetic autonomic neuropathy
1Oxford Centre of Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK. vivien.toh@orh.nhs.uk
Background:
Symptomatic postural hypotension in diabetes is uncommon. When it does occur, it can prove debilitating and difficult to treat. We report here the therapeutic challenges encountered in managing a patient with severe postural hypotension secondary to diabetes-related autonomic neuropathy.
Case Report:
A 69-year-old gentleman with a 23-year history of Type 1 diabetes mellitus and multiple microvascular complications was admitted with symptoms of severe postural hypotension. Cardiovascular autonomic testing confirmed the presence of severe autonomic neuropathy. He failed to respond to non-pharmacological measures, fludrocortisone, midodrine, octreotide, erythropoietin and increased caffeine intake. Eventually he was commenced on half a Cafergot suppository (giving him a dose of ergotamine 1 mg and caffeine 50 mg) which resulted in dramatic clinical improvement.
Conclusion:
Ergotamine may be considered in refractory cases of postural hypotension.
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