BERKELEY, CA (UroToday.com) - Described over 50 years ago, the condition known as idiopathic orthostatic cyclic edema is associated with nocturia, chronic refractory urticaria and failure to lose weight. It is thought that a defect in the response from the sympathetic nerve endings allows water to leak from intravascular to extravascular spaces in the orthostatic position. Sympathetic amines are believed effective in treating this condition by means of correcting this defect. A water load test is used to diagnose the condition once other causes of inability to clear a free water load have been excluded, e.g., hypothyroidism, congestive heart failure, cirrhosis, or nephrosis. Failure to excrete more than 55% of an ingested water load of 1500cc in 30 minutes over a four hour period is thought to be abnormal, though modifying the definition to 75% increases the population considered to have this diagnosis significantly. The test is repeated with the patient supine and standing.

Check and colleagues from the University of Medicine and Dentistry of New Jersey made a diagnosis of idiopathic orthostatic cyclic edema in two patients that had presented with symptoms they thought compatible with painful bladder syndrome/interstitial cystitis. Both had dramatic responses in their pelvic pain and bladder symptoms within 2 days of initiation of dextroamphetamine sulfate (one 10mg in the morning and 10mg at noon; the other on 20mg daily extended release preparation).

The authors conclude that it is worth looking for this syndrome in selected PBS/IC patients.

Clinical and experimental obstetrics & gynecology, 32(4):247-249; 2005

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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