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9-Alpha-Fluorohydrocortisone in the Treatment of Postural Hypotension in Diabetic Autonomic Neuropathy

A double-blind crossover study of fludrocortisone, 0.1 mg. twice daily, and placebo is reported in six diabetics with troublesome symptoms of postural hypotension due to autonomic neuropathy. During treatment with the active preparation there was an increase in the lying and tilted systolic blood pressure, a decrease in orthostatic tachycardia, and an increase in the total plasma volume and body weight, but with no change in plasma or urine osmolality. The symptoms of postural hypotension improved in four patients, while two patients with a low serum albumin developed ankle edema during treatment with fludrocortisone. It is concluded that fludrocortisone is effective in diabetics with symptomatic postural hypotension, but should be used with caution in patients with a low serum albumin.