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Dr. Andrew Rynne

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What causes BP variations in a person with insulinoma?

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Dr. Prasanna Heijebu

General & Family Physician

Practicing since :2010

Answered : 1423 Questions

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Posted on Tue, 20 Oct 2015 in Medicines and Side Effects
Question: (I had dizziness from my allergies for years but this is different. I also had Insulinoma when I was a teenager.) I feel it worst when I get up in the am. It no longer related to my moving about. It can last well into the day. sometimes coffee helps. I have also noticed that though I have been told that I had low BP when I was young over the years it seem to run in the 130/ range. Now it is up and down. I was 139/77 at 8:38 about an hour or less after I gotten up then an hour later it was 104/62. Now it 11:40 and my BP is still down below 110 almost 100/ for awhile. I feel like I am going to faint when it is low. What is positional BP like?
doctor
Answered by Dr. Prasanna Heijebu 13 hours later
Brief Answer:
Possible Autonomic dysfunction.

Detailed Answer:
Hello, Madam.

I understand your concern.

The blood pressure fluctuations in your case could possibly represent Orthostatic hypotension which could be a manifestation of underlying autonomic dysfunction.

This OH is known to cause wide swings in BP.

For, Confirmation I advise you to undergo the following baseline tests.

1.Tilt table testing to test adrenergic vasomotor function and cardiac sympathetic function.

2.Cardiac response to deep breathing and R-R interval to evaluate cardio-vagal functions.

3.Cardiac response to Valsalva maneuvers to test parasympathetic innervation to the heart.

4.Quantitative Sudomotor Axon Reflex Testing (QSART) to evaluate the postganglionic segment of the thermoregulatory pathway.

Medications like Fludrocortisone are generally prescribed in your cases if AD related OH is diagnosed.Please check with your doctor if he shares my view and if can prescribe them to you.

Post your further queries if any.
Thank you.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Prasanna Heijebu 30 hours later
I not so sure that the problem. How long does the change in BP last? My low BP can last till mid afternoon. I get up before 8am in the morning. I have been under a lot of stress and I wonder if stress has anything to do with my it?
doctor
Answered by Dr. Prasanna Heijebu 6 hours later
Brief Answer:
Stress can also contribute to BP fluctuations

Detailed Answer:
Hello, Madam.

I understand your concern.

The change in BP can last for hours as long as 4-6 hours in a day before rising again and further again normalising.The cycles can repeat asynchronously.

Stress can also be a major contributor of these fluctuations in BP to a large extent.

If you are pretty much stressed, a short course of anxiolytic drugs like Alprazolam may help.Please check with your doctor if he shares my view and if can prescribe these medications to you.

A complete evaluation for autunomic dysfunction will you on a safe note.

Post your further queries if any.
Thank you.




Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Prasanna Heijebu 6 hours later
which Dr would do the autonomic dysfunction evaluation. A cardiac Dr? thanks for your time.
doctor
Answered by Dr. Prasanna Heijebu 3 hours later
Brief Answer:
Consult both Neurologist and Cardiologist.

Detailed Answer:
Hello, Madam.

I understand your concern.

You need to consult both cardiologist(who has an additional qualification in electrophysiology) and a Neurologist for expert joint management.

Thank you.
Above answer was peer-reviewed by : Dr. Sonia Raina
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