title: Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single center experience.
abstract: BACKGROUND
  We present our single center experience of 27 patients of hyperadrenergic postural orthostatic tachycardia syndrome (POTS).
  
  
  METHODS
  In a retrospective analysis, we reviewed the charts of 300 POTS patients being followed at our autonomic center from 2003 to 2010, and found 27 patients eligible for inclusion in this study. POTS was defined as symptoms of orthostatic intolerance (of greater than six months' duration) accompanied by a heart rate increase of at least 30 bpm (or a rate that exceeds 120 bpm) that occurs in the first 10 min of upright posture or head up tilt test (HUTT) occurring in the absence of other chronic debilitating disorders. Patients were diagnosed as having the hyperadrenergic form based on an increase in their systolic blood pressure of ≥ 10 mm Hg during the HUTT (2) with concomitant tachycardia or their serum catecholamine levels (serum norepinephnrine level ≥ 600 pg/mL) upon standing.
  
  
  RESULTS
  Twenty seven patients, aged 39 ± 11 years, 24, (89%) of them female and 22 (82%) Caucasian were included in this study. Most of these patients were refractory to most of the first and second line treatments, and all were on multiple combinations of medications.
  
  
  CONCLUSIONS
  Hyperadrenergic POTS should be identified and differentiated from 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.
authors.affiliation: Department of Medicine,University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Khalil
authors.initials: K
authors.lastname: Kanjwal
authors.forename: Bilal
authors.initials: B
authors.lastname: Saeed
authors.forename: Beverly
authors.initials: B
authors.lastname: Karabin
authors.forename: Yousuf
authors.initials: Y
authors.lastname: Kanjwal
authors.forename: Blair P
authors.initials: BP
authors.lastname: Grubb
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000378:metabolism* / Q000503:physiopathology; D001794:Blood Pressure; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D009820:Ohio; D056888:Patient Positioning; D054972:Postural Orthostatic Tachycardia Syndrome / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D011187:Posture; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018667:Tilt-Table Test; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D009638:Norepinephrine