Hi Nick, I have a special place in my heart for those POTS folks with Hyperadrenergic POTS—
the form I had. It was so incredibly miserable—I’m sure you’re familiar with how it feels! The best way to diagnose it is to check catecholamines after lying down in a quiet place for about 30 minutes,
then rechecking them after being vertical for 10 minutes. It is best to have the IV in place prior to drawing blood so that the needle stick doesn’t increase catecholamine levels. Hyperadrenergic POTS patients will have a pretty good surge of norepinephrine. You can get a pretty good feel for the diagnosis on a tilt table, as these folks will experience increased blood pressure upon tilt (and will be less likely to faint). Interestingly, my son was not hyperadrenergic (he had more of a neurocardiogenic syncope presentation) and my daughter was neither! She had a lower level of POTS, but still failed a tilt table test. Interesting that we are all in the same family. What it suggested to me was that perhaps the form of POTS was less important for treatment than what we initially thought (which turned out to be the case). I hope this helps!