CARDIOVASCULAR AUTONOMIC INSUFFICIENCY IN A PATIENT WITH METASTATIC MALIGNANCY

A case of cardiovascular autonomic insufficiency is described in a cac hectic 70-year-old man with widely metastatic small-cell tumor. The pa tient experienced disabling syncopal episodes in association with seve re postural hypotension. Tests of cardiovascular autonomic insufficien cy were abnormal. The introduction of fludrocortisone and the use of e lastic stockings produced palliation of the symptomatology, but his co ndition deteriorated and he died. Autopsy demonstrated unexpectedly ex tensive tumor invasion of autonomic nervous tissue. Although cardiovas cular autonomic insufficiency (CAI) has been described in association with malignancy and malnutrition, local tumor invasion of autonomic ne rvous tissue and radiation injury may have been other possible, albeit unusual, etiologic factors. This case illustrates the differential di agnosis of hypotension and CAI in patients with advanced metastatic ma lignancy and also emphasizes the need for autopsy studies when specula ting as to the cause of CAI in this group of patients.