Hyperadrenergic POTS: Clinical presentation and mgmt

Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome | June 2011

In recent years there has been a substantial improvement of our understanding of POTS. Although the exact etiology remains elusive, we know that the syndrome of postural tachycardia is not a single clinical entity, but rather a heterogeneous group of various related clinical syndromes having a final common presentation of orthostatic intolerance

The commonest form of POTS, called the neuropathic or partial dysautonomic form, results from neuropathy preferentially involving the lower extremities with resultant venous pooling

Another group of patients suffer from centrally driven abnormal sympathetic activation. This form of postural tachycardia syndrome is called hyperadrenergic POTS, and comprises about 10% of all POTS patients. Patients suffering from hyperadrenergic POTS have been observed to have an orthostatic plasma norepinephrine level =600 pg/mL and a rise of systolic blood pressure (SBP) of =10 mm Hg upon standing.

We present our single center experience of 27 hyperadrenergic POTS patients.


POTS Symptoms



potS meds



Patients of hyperadrenergic POTS should be identified and differentiated from those with neuropathic POTS. These patients are usually difficult to treat and there are no standardized treatment protocols known at this time for patients with hyperadrenergic POTS. A randomized control trail in future may help evaluate the role of optimal therapy in these patients

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