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Neurogenic orthostatic hypotension after treatment with sorafenib
  1. Catherine Wegner Wippel1,
  2. Hari Deshpande2,
  3. Huned Patwa3 and
  4. Aldo J Peixoto4
  1. 1Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Neurology, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4Nephrology, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Catherine Wegner Wippel; wegnerwippel.cath{at}


A man in his 70s with a history of fatigue, abdominal pain, and a palpable abdominal mass was found to have a peritoneal desmoid tumour. One year after diagnosis, he was prescribed sorafenib to limit tumour growth. Two months later, he developed dyspnoea on exertion and lower extremity weakness and was reported to have supine hypertension and orthostatic hypotension. On formal autonomic testing, he was noted to have severely impaired sympathetic responses and marked orthostatic hypotension without appropriate chronotropic response. A decision to hold sorafenib was made, and treatment was started with graduated compression stockings, liberal fluid and sodium intake, and midodrine. The patient had a modest and gradual improvement in his symptoms. To our knowledge, this is the first reported case of orthostatic hypotension related to sorafenib or any vascular endothelial growth factor inhibitors.

  • Cardiovascular system
  • Peripheral nerve disease
  • Chemotherapy

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  • Contributors CWW, HD, HP and AJP conceived the presented idea. CWW and AJP collected all clinical information pertaining to the case. CWW performed the literature review and took the lead in writing the manuscript. AJP, HD and HP supervised the findings of this work, provided critical feedback and helped shape the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.