The etiology of autonomic neuropathy in insulin-dependent diabetes mellitus (IDDM) is unknown. Previous studies have noted the presence of anti-adrenal medullary antibodies in IDDM. Recently, we have also demonstrated the presence of anti-sympathetic ganglia antibodies in IDDM. We initiated a study to evaluate whether subjects with complement-fixing anti-adrenal medullary (CF-ADM) and anti-sympathetic ganglia (CF-SG) antibodies have a decreased catecholamine response to change in posture. Seven IDDM subjects aged 19–41 yr with duration of disease 5–21 yr at the time of the posture study were evaluated. Serums collected longitudinally were evaluated for the presence of CF-ADM and CF-SG antibodies. Three IDDM subjects were CF-ADM and CF-SG at all testing intervals (Ab group). Four IDDM subjects were CF-ADM+ and/or CF-SG+ on at least one testing date (Ab+ group). Baseline mean norepinephrine and epinephrine levels were not significantly different in Ab+ and Ab subjects. Norepinephrine levels 5 min after standing were mean ± SD 227 ±16 and 419 ± 48 pg/ml for Ab+ and Ab subjects, respectively (P < .03). The means of the 5-min minus basal norepinephrine levels were 88 ± 42 (Ab+) and 207 ± 26 (Ab) pg/ml (P < .03). Mean epinephrine levels after 5 min of standing were 35 ±16 (Ab+) and 101 ± 44 (Ab) pg/ml (P < .03). The means of the 5-min minus basal epinephrine levels were 1 ± 5 (Ab+) and 43 ± 38 (Ab) pg/ml (P < .03). Mean change in systolic blood pressure on standing was not different in the two groups. This suggests that CF-ADM and CF-SG are associated with a decreased catecholamine response to change in posture.

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