We describe a case with Parkinson's Disease (PD), neurogenic orthostatic hypotension (nOH) and profound postprandial hypotension (PPH) and reviewed our database to determine the degree of PPH in central (multiple system atrophy, MSA) versus peripheral (PD) autonomic failure due to alpha-synucleionopathies .

 Postprandial hypotension (PPH) is a significant co-morbid condition, affecting patients with autonomic failure due to alpha-synucleionopathies.  Our previous data showed no difference in PPH severity between pure autonomic failure patients and MSA. 

 Patient history and examination was obtained from patient and hospital records.  27 total cases were selected from patients seen in Vanderbilt Autonomic Dysfunction Center in the last 5 years, 7 men and 3 women with PD including index patient, 11 men and 6 women with MSA. Diagnosis based on data at hospitalization. PPH was measured sitting before and 120 minutes after a high carbohydrate breakfast.

Postprandial hypotension can be greater than orthostatic hypotension in patients with PD.  Patients with PD and nOH are more likely to develop postprandial hypotension compared to MSA patients, which may be due to less residual sympathetic tone.  Postprandial hypotension should be considered in diagnostic evaluation and treatment.