Sympathetic autonomic dysfunction. Programmed subcutaneous noradrenaline administration via microdosing pump.

Sympathetic dysfunction is characterized by postural hypotension, decreasing blood pressure without compensatory tachycardia during graded supine ergometric exercise, impaired catecholamine metabolism, and hypersensitivity to catecholamines. We report on eight patients, seven with sympathetic dysfunction, of whom three patients were treated for the first time with programmed subcutaneous noradrenaline administration by means of a microdosing pump over a time period of 1.5-13 months. A clear improvement in blood pressure values, orthostasis tolerance, and exercise capacity has been observed in these three patients which permit them to extend their action radius. Adjustment of the noradrenaline dose to the wide range of everyday stress and the possible occurrence of adrenoreceptor desensitization, however, remains a severe problem.