Abstract
Neurogenic orthostatic hypotension (nOH) is a debilitating manifestation of autonomic dysfunction and is most commonly associated with neurodegenerative disorders, though it can occur in isolation. Pure autonomic failure (PAF) is a rare and often underrecognized cause of nOH, particularly in older adults. We report the case of an 80-year-old man with hereditary hemochromatosis who presented with recurrent falls due to severe orthostatic hypotension. Orthostatic vitals demonstrated a marked blood pressure drop with minimal heart rate response consistent with a neurogenic etiology. He lacked motor, cognitive, or sensory features of neurodegenerative disease, and extensive evaluation excluded secondary causes, supporting a diagnosis of PAF. Management included midodrine, fludrocortisone, compression garments, nutritional supplementation, and a comprehensive inpatient rehabilitation program focused on mobility, endurance, and activities of daily living. Over a 25-day inpatient rehabilitation course, the patient’s Functional Independence Measure score improved from 71/126 to 100/126, with significant gains in ambulation and self-care. This case highlights PAF as an important cause of nOH in older adults and demonstrates that early recognition and a multidisciplinary approach can substantially reduce fall risk and restore functional independence.
Recommended Citation
Cooper, Lauren; Studt, William; Islam, Rayan; and Weinberger, Richard
(2026)
"A Case of Neurogenic Orthostatic Hypotension Secondary to Pure Autonomic Failure,"
The Journal of Integrated Primary Care: Vol. 3:
Iss.
2, Article 1.
Available at:
https://digitalcommons.pcom.edu/jipc/vol3/iss2/1
Included in
Internal Medicine Commons, Neurology Commons, Other Rehabilitation and Therapy Commons, Social and Behavioral Sciences Commons
