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The role of delayed orthostatic hypotension in the pathogenesis of chronic fatigue

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By Streeten DH, Anderson GH Jr • • April 15, 1998

Past studies have shown that severe fatigue was the presenting
symptom in six of seven patients with delayed orthostatic
hypotension and that tilt table-induced hypotension was found
in 22 of 23 patients with the chronic fatigue syndrome. We
have determined the prevalence of fatigue, volunteered in
response to a nonspecific pre-examination questionnaire used
in 431 patients, each subsequently diagnosed as having one of
eight neurological or endocrine disorders. The results show
that fatigue is a very common symptom in patients with delayed
orthostatic hypotension (n = 21), as well as both primary (n =
30) and secondary (n = 106) hypocortisolism: 70-83% in all
groups. In contrast, fatigue was an uncommon complaint in
patients with multiple system atrophy (MSA) (n = 30),
pituitary disorders without hypocortisolism (n = 106) or
idiopathic hirsutism (n = 96): 7-33% in all groups, and was
intermediate in prevalence in patients with acute
hyperadrenergic orthostatic hypotension (n = 32): 41%. It is
concluded that fatigue commonly results from delayed
orthostatic hypotension and all forms of hypocortisolism but
is less common in patients with acute orthostatic hypotension,
both idiopathic and due to MSA, which more commonly present
with lightheadedness or syncope.

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