MomtoGiuliana Posted March 10, 2005 Report Share Posted March 10, 2005 Radha started a thread asking how a doctor determines whether or not your POTS is hyperadrenergic. I discovered how little I know as I tried to help answer the question.What I did find on some reading -- and I still may be off on this-- is that there are at least two variants of POTS: hyperadrenergic and neuropathic. Here is a basic article on neuropathic POTS:Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, Biaggioni I, Ertl A, Black B, Robertson D,The neuropathic postural tachycardia syndrome. New England Journal of Medicine. 343(14):1008-14. October 2000Here is the Abstract:BACKGROUND: The postural tachycardia syndrome is a common disorder that is characterized by chronic orthostatic symptoms and a dramatic increase in heart rate on standing, but that does not involve orthostatic hypotension. Several lines of evidence indicate that this disorder may result from sympathetic denervation of the legs. METHODS: We measured norepinephrine spillover (the rate of entry of norepinephrine into the venous circulation) in the arms and legs both before and in response to exposure to three stimuli (the cold pressor test, sodium nitroprusside infusion, and tyramine infusion) in 10 patients with the postural tachycardia syndrome and in 8 age- and sex-matched normal subjects. RESULTS: At base line, the mean (+/-SD) plasma norepinephrine concentration in the femoral vein was lower in the patients with the postural tachycardia syndrome than in the normal subjects (135+/-30 vs. 215+/-55 pg per milliliter [0.80+/-0.18 vs. 1.27+/-0.32 nmol per liter], P=0.001). Norepinephrine spillover in the arms increased to a similar extent in the two groups in response to each of the three stimuli, but the increases in the legs were smaller in the patients with the postural tachycardia syndrome than in the normal subjects (0.001+/-0.09 vs. 0.12+/-0.12 ng per minute per deciliter of tissue [0.006+/-0.53 vs. 0.71+/-0.71 nmol per minute per deciliter] with the cold pressor test, P=0.02; 0.02+/-0.07 vs. 0.23+/-0.17 ng per minute per deciliter [0.12+/-0.41 vs. 1.36+/-1.00 nmol per minute per deciliter] with nitroprusside infusion, P=0.01; and 0.008+/-0.09 vs. 0.19+/-0.25 ng per minute per deciliter [0.05+/-0.53 vs. 1.12+/-1.47 nmol per minute per deciliter] with tyramine infusion, P=0.04). CONCLUSIONS: The neuropathic postural tachycardia syndrome results from partial sympathetic denervation, especially in the legs.__________________________________________________If anyone has the neuropathic variant of POTS, perhaps they can respond and describe how it was diagnosed and what treatments have helped --especially if the treatment is any different for this variant than for hyperadrenergic variant. I think some to many of us may not know which variant we have? That is my guess. I was never diagnosed with one or the other. The other thing I wonder is whether some of us have a combination of the two.I also don't know if or how the symptoms differ. Perhaps someone can answer that as well.Hope this helps Radha!Katherine Quote Link to comment Share on other sites More sharing options...
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