POTS vs Hyperadrenergic POTS?

[nick.ced]

Hi guys!

I’m not clear on the difference of what makes someone Hyperadrenergic as opposed to just regular POTS?

If anyone can help me out, please do :)!

Thanks in advance!

[Dr. Diana]

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!

[qanik]

Just as Dr Diana said you will see the BP go up instead of down. I was dx many years ago at Mayo ( not my favorite place) and had the exact test she describes above. My catecholamines were off the chart when drawn after 30 minutes of lying flat in a dark room and upon tilt ( off meds for 2 weeks)here is what i got- Resting lying flat HR 78, BP 132/78—upright 1 minute HR 102, BP 154/96, upright 3 minutes HR 124, BP 188/108 Upright 5 minutes HR 148 BP 204/122. Test discontinued at that point by autonomic doctor. Although I am much more controlled now with beta blockers I still fail the tilt with my HR.
Q

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