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. (Cardiol J
2011; 18, 5: 527–531
