Adrenal Insufficiency and POTS

[Sam123]

Differentiating Adrenal Insufficiency from POTS is tricky. Almost same symptoms. Can you please describe some hints that could help differentiating between them. I haven't been diagnosed  yet. But I feel very tired even Im laying down and sometimes I feel the fainting episode when Im sitting or even laying down.  There is almost always 25-30 beats difference between laying down and standing and rarely exceed 30. When I feel more relaxed, and happy the difference reduces to 20 beats (80 to 100). 

Sometimes I feel like Adrenal rush, fear, and increased heart rate when Im sitting. Properanolol helps a lot in such case. Can I conclude from the last description that I dont have Adrenal Insufficiency because adrenaline causes these symptoms? Does Adrenal Insufficiency means also low adrenaline or it is only related  to low cortisol?

I started to suspect that my symptoms are more related to anxiety.

[p8d]

Have you been checked for hyperadregenic POTS?  Some of what you describe sounds like it.  You would need a laying and standing 10 minute catecholamines test.  Are you seeing a POTS specialist?  They generally do this testing.

[vepa]

Adrenal insufficiency is something that can easily be tested by an endocrinologist. It typically primarily affects cortisol, but can affect other hormones and can cause POTS symptoms. You can certainly have adrenal insufficiency and not necessarily have low adrenaline. 

I highly suggest you get your hormone levels checked. I mentioned this on an earlier thread, but many medical professionals categorize POTS as a syndrome, rather than its own illness. Even if you have POTS, the medical goal is to find out what's causing it. Its pretty uncommon to just have POTS without any underlying cause. 

So in your case, you could very well have adrenal insufficiency that is causing POTS.  It's not necessarily a question of one or the other or a matter of differentiating. 

 

[Sam123]

@p8d I haven't seen POST specialist because there are no such doctors interested in POTS in Yemen. I will see a cardiac  soon. Do you mean by catecholamines test measuring HR and BP?

Thank you.

[p8d]

I sincerely hope that the cardiologist can help you.  Having a knowledgeable, caring specialist is so important.

Catecholamines are: 

"are hormones made mostly by your adrenal glands as a reaction to stress.

When you feel stressed, these hormones increase heart rate, blood pressure, breathing rate, muscle strength, and mental alertness." 

According to this site https://www.webmd.com/heart-disease/catecholamines-14697#1

I had a blood test and a urine test.  

I take methyldopa for norepinephrine surges and it works very well.

[Sam123]

@p8d Thanks for the information. Can I understand from your description that stress can cause the symptoms of POTS? I havent been diagnosed with POTS but I find Propronalol very helpful. Only 10 mg a day. This what makes me suspect that I dont have POTS. Only adrenaline surge and anxiety!

[yogini]

Propranolol is a beta blocker which regulates your heart rate and blood pressure.  It is a medication that is commonly used to treat POTS.   So if you are feeling better on it, that does not rule out POTS.

[p8d]

My understanding is that stress may be a result but not cause of POTS.  Hopefully your cardiologist will do a "poor man's tilt table test" when you are not taking propranolol which, as Yogini states regulates heart rate and blood pressure.  If, after laying down for several minutes when you stand upright your heart rate increases greater than 30 beats you likely have POTS.  Usually my cardiologist will test my heart rate after immediately standing then 2 minutes, 5 minutes and 10 minutes.  Blood pressure can drop significantly or for some people it actually rises.  If you check the information section on the main page of this site there is a lot of information that should be helpful.