scholarly journals Circulating levels of growth hormone in postural orthostatic tachycardia syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Madeleine Johansson ◽  
Fabrizio Ricci ◽  
Janin Schulte ◽  
Margaretha Persson ◽  
Olle Melander ◽  
...  
Keyword(s):  
Heart Rate ◽  
Growth Hormone ◽  
Orthostatic Intolerance ◽  
High Sensitivity ◽  
Symptom Assessment ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Daily Life Activities ◽  
Median Plasma ◽  
Symptom Assessment Scale ◽  
Plasma Gh

AbstractPostural orthostatic tachycardia syndrome (POTS) is a cardiovascular autonomic disorder with poorly understood etiology and underlying pathophysiology. Since cardiovascular morbidity has been linked to growth hormone (GH), we studied GH levels in patients with POTS. We conducted an age-sex-matched case–control study in patients with POTS (age 31 ± 9 years; n = 42) and healthy controls (32 ± 9 years; n = 46). Plasma GH levels were measured using high-sensitivity chemiluminescence sandwich immunoassay. The burden of orthostatic intolerance symptoms was assessed by the Orthostatic Hypotension Questionnaire (OHQ), consisting of a symptom assessment scale (OHSA) and a daily activity scale (OHDAS). POTS patients had significantly higher composite OHQ score than controls, more symptoms and less activity. Supine heart rate and diastolic blood pressure (BP), but not systolic BP, were significantly higher in POTS. Median plasma GH levels were significantly lower in POTS (0.53 ng/mL) than controls (2.33 ng/mL, p = 0.04). GH levels were inversely related to OHDAS in POTS and supine systolic BP in POTS and controls, but not heart rate neither group. POTS is associated with lower GH levels. Impairment of daily life activities is inversely related with GH in POTS. A higher supine diastolic BP is inversely associated with GH levels in POTS and healthy individuals.

Downregulation of growth hormone in postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Johansson ◽  
J Schulte ◽  
F Ricci ◽  
M Persson ◽  
R Sutton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Growth Hormone ◽  
Plasma Levels ◽  
Orthostatic Intolerance ◽  
Statistical Tests ◽  
Growth Hormone Level ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Funding Source ◽  
Significant Difference

Abstract Background Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder occurring predominantly in young women. POTS is characterized by an excessive heart rate increase when assuming upright posture accompanied by symptoms of orthostatic intolerance. The pathophysiology of POTS has not been fully established and is believed to be multifactorial. Purpose We aimed to investigate the alterations in circulating growth hormone level in POTS. Methods We conducted an age-matched case-control study enrolling 42 patients with POTS (age 31±9 years; 36 women) verified by positive head-up tilt testing and cardiovascular autonomic tests, and 46 controls (32±9 years; 35 women) with negative active standing test and no history of syncope, orthostatic intolerance and endocrine disease. We measured plasma levels of growth hormone using a high-sensitivity chemiluminescence immunoassay in relation to presence of POTS diagnosis. All study participants completed the validated Orthostatic Hypotension Questionnaire (OHQ), consisting of two components: the symptoms assessment scale (OHSA) and daily activity scale (OHDAS) to evaluate the burden of symptoms. We applied standard statistical tests for group differences. Growth hormone values were log-transformed and standardized before the group comparison. Results POTS patients had significantly lower plasma levels of growth hormone (ng/mL) (median=0.53, IQR, 0.10–2.83 vs. median=2.33, IQR, 0.26–7.2, p=0.04) than controls. Levels of growth hormone were reversely related to OHDAS (p=0.049) among POTS patients. Supine heart rate was significantly higher in POTS patients (69.0±11.1 beats/min vs. 63.3±10.8 beats/min, p=0.02), as well as diastolic blood pressure (72.9±9.1 mmHg vs. 69.0±8.5 mmHg, p=0.04). We observed no significant difference in supine systolic blood pressure (116.6±13.3 mmHg vs. 115.2±10.0 mmHg, p=0.60). POTS patients had a significantly higher composite OHQ score than controls (60.0±18.6 vs. 4.2±7.5, p<0.001), as well as OHSA (36.2±10.0 vs. 3.6±6.4, p<0.001) and OHDAS (23.8±9.7 vs. 0.6±1.3, p<0.001). Conclusion(s) Our study shows that patients with POTS have significantly reduced plasma levels of circulating growth hormone. Lower growth hormone levels among POTS patients are associated with increased impairment of daily life activities. Further studies are necessary to confirm our findings in the independent populations and explain the mechanisms behind this alteration. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Crafoord Foundation, Swedish Heart and Lung Foundation

Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amna A Butt ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Tibial Nerve ◽  
Sensory Nerves ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

scholarly journals Postural orthostatic tachycardia syndrome in primary care: diagnosis, treatment and a case of African-American man presenting with POTS

2019 ◽  
Vol 12 (9) ◽  
pp. e229824
Author(s):  
Andrew T Del Pozzi ◽  
Michael Enechukwu ◽  
Svetlana Blitshteyn
Keyword(s):  
Heart Rate ◽  
Differential Diagnosis ◽  
African American ◽  
Clinical Features ◽  
Orthostatic Intolerance ◽  
Treatment Options ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Caucasian Women

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder characterised by orthostatic intolerance and a rise in heart rate by at least 30 bpm or an absolute heart rate value of at least 120 bpm within 10 min of standing or during a tilt table test. Overwhelmingly, POTS affects young Caucasian women, which can lead physicians to miss the diagnosis in men or non-white patients. We describe a case of 29-year-old African-American man who developed lightheadedness, generalised weakness, tachycardia and palpitations and was subsequently diagnosed with POTS. We review its clinical features, differential diagnosis, pathophysiology and treatment options. We also emphasise that POTS should be considered as a differential diagnosis in any patient presenting with typical clinical features, who may not be in the usual demographics of the disorder.

Posturalinės ortostatinės tachikardijos sindromas

2013 ◽  
Vol 23 (1) ◽  
pp. 127-132
Author(s):  
Alina Vilkė ◽  
Justina Mikšaitė ◽  
Andrius Macas
Keyword(s):  
Heart Rate ◽  
Atrial Flutter ◽  
Autonomic Dysfunction ◽  
Mayo Clinic ◽  
Orthostatic Intolerance ◽  
Normal Sinus Rhythm ◽  
Exercise Intolerance ◽  
Vertical Position ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Patients Âgés

Orthostatic intolerance defines a group of symptoms characterized by cerebral hypo-perfusion and/or sympathetic activation that appear on standing upright and remit in the supine position. Patients may complain of headache, nausea, abdominal pain, light headedness, diminished concentration, syncope, anxiety, weakness, fatigue, exercise intolerance, palpitations, dyspepsia, and chest pain. POTS criteria: increased heart rate 30 beats/min or more contractions within the first 10 min of a change in the vertical position, there is no position-induced hypo-tension, orthostatic intolerance symptoms. POTS is the most common form of orthostatic intolerance. This is the most common syndrome among young people, who have autonomic dysfunction clinic. POTS patients ages - young, between 14 and 45 years. POTS ethology is heterogeneous. It was found that POTS can cause a variety of reasons, but which is primary and which are secondary - remains unclear. We assessed the case: 28 years old patient was hospitalized to Lithuanian University of Health Sciences Kaunas hospital for Abnormal nor epinephrine surgical treatment of oesophageal achalasia. The start of surgery clearance and adrenergic receptor sensitivity in idiopathic (laparoscopic cardiomiotomy) and gas insuffliation was madeorthostatic intolerance.without any complications. But when the patient‘s position was changed (reverse Tredelenburg) was monitorised atrial flutter (he-art rate 130 beats per minute, blood pressure 146/106 mmHg). For atrial flutter correction were used KCl, Mg SO4, and intravenous esmolol. After that, heart rate gradually decreased from 130 beats/ min to 92-80 beats/min. During all surgery, the patient‘s condition was stable, but a normal sinus rhythm observed at the end of operation, when the patient was returned to her primary position.There was a research in Mayo Clinic (Minnesota, USA) which objective - to investigate perioperative patients with postural orthostatic tachycardia syndrome (POTS) preparation, and to identify unexpected complications during operation. The research was conducted on the 152 patients to identify all surgical procedures performed during general anaesthesia between January 1, 1993 andDecember 31, 2006 at Mayo Clinic. There were selected 13 patients (12 women, 1 man) of 152. From research there was found that autonomic dysfunction associated with POTS may present unusual physiologic challenges in the perioperative period.

scholarly journals 7Demographics of postural orthostatic tachycardia syndrome in adult population

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mostafa Abdeen ◽  
Eda Hasbay ◽  
Eliz Hasbay ◽  
Cesar Peralta ◽  
Hafsa Fatima ◽  
...  
Keyword(s):  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Adult Population ◽  
Clinical Manifestations ◽  
Electronic Records ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Black African ◽  
Gender And Age ◽  
Male Patients ◽  
Unclear Etiology

Abstract Background Postural Orthostatic Tachycardia Syndrome (POTS) is a dysautonomia of unclear etiology. POTS is defined as a form of orthostatic intolerance characterized by an increase in heart rate ≥ 30 bpm or to a heart rate ≥120 bpm upon standing. The clinical manifestations include dizziness, palpitations fatigue, anxiety, nausea and fainting. There is a paucity of data available on adult population. This study aims to identify and evaluate demographic features of adult patients with POTS in a large tertiary specialty clinic. Methods 447 patients diagnosed with POTS between 8/21/2018 and 8/20/2019 were randomly selected from our electronic records, and clinical data obtained during initial outpatient evaluation was reviewed retrospectively for race, gender and age. Results Out of 447 patients, 407 (91%) are female and 40 (9%) are male. Amongst them, 417 (93%) patients are White Caucasian of which 381 (91%) are female and 36 (9%) are male; 12 (3%) are Black/African-American of which 11 (92%) are female and 1 (8%) is male; 10 (2%) are Hispanic of which 100% are females; 4 (1%) are Asian of which 2 (50%) are females and 2 (50%) are males and 4 from other races of which 3 (75%) were female and 1 (25%) was male. Patients had a mean age of 32.9 with a standard deviation of 11.96. Conclusions POTS predominates in females, middle age population, and may be heavily prevalent in White Caucasians. Key messages Further clinical studies on more geographically spread populations are encouraged to support our findings on racial prevalen

Postural orthostatic tachycardia syndrome (POTS) occurring during treatment for breast cancer

2021 ◽  
Vol 14 (8) ◽  
pp. e242472
Author(s):  
Deshveer Babra ◽  
Suhyun Youn ◽  
Senan Devendra
Keyword(s):  
Breast Cancer ◽  
Heart Rate ◽  
Differential Diagnosis ◽  
Beta Blocker ◽  
Orthostatic Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Common Condition ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
New Onset

Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.

Higher postural heart rate increments on head-up tilt correlate with younger age but not orthostatic symptoms

2013 ◽  
Vol 115 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Colleen T. Ives ◽  
Kurt Kimpinski
Keyword(s):  
Heart Rate ◽  
Healthy Subjects ◽  
Orthostatic Intolerance ◽  
Significant Negative Correlation ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Age Group ◽  
Younger Age ◽  
Significant Difference ◽  
Head Up Tilt ◽  
Orthostatic Symptoms

Reports have shown that younger individuals present with higher postural heart rate increments on head-up tilt (HUT). However, a correlation between the degree of heart rate increment and symptoms of orthostatic intolerance has not been determined. The objective of this study was to determine whether higher postural heart rate increments during HUT correlate with symptoms of orthostatic intolerance in healthy subjects. Postural heart rate increment on HUT did not differ between men and women ( P = 0.48) but did show a significant decrease by age group ( P < 0.0001). There was a significant negative correlation between heart rate increment on HUT and age [ r = −0.63 (−0.73, −0.51), r2 = 0.400; P < 0.0001]. There was a significant difference with respect to symptoms of orthostatic intolerance by sex ( P = 0.03) but not age ( P = 0.58). There was no significant correlation between either symptoms of orthostatic intolerance and age [ r = −0.13 (−0.31, 0.06), r2 = 0.017; P = 0.17] or heart rate increment on HUT and symptoms of orthostatic intolerance [ r = 0.15 (−0.04, 0.33), r2 = 0.022; P = 0.13]. The results demonstrate that higher postural heart rate increments in younger individuals do not result in an increase in orthostatic intolerance. This highlights the potential need for a reevaluation of the diagnostic criteria for postural orthostatic tachycardia syndrome in younger individuals.

scholarly journals P.040 Efficacy and safety of periodic albumin infusions in refractory postural orthostatic tachycardia syndrome: a comparative study

2019 ◽  
Vol 46 (s1) ◽  
pp. S24
Author(s):  
ZA Siddiqi ◽  
D Blackmore ◽  
A Soloway
Keyword(s):  
Heart Rate ◽  
Comparative Study ◽  
Normal Saline ◽  
Orthostatic Intolerance ◽  
Venous Catheter ◽  
Primary Outcome Measure ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Open Label ◽  
Multiple Treatments

Background: Postural Orthostatic Tachycardia Syndrome (POTS) causes excessive heart rate and orthostatic intolerance on standing. About 25% patients have refractory POTS. Saline infusions reduce improve quality of life in such patients. Intravenous albumin expands circulatory volume by increasing plasma oncotic pressure. Efficacy of albumin infusions in POTS has not been studied. Methods: To assess the efficacy of albumin infusions in refractory POTS we treated patients with weekly or biweekly intravenous infusions of either 5% albumin in normal saline (n=16) or normal saline alone (n=7) in this open label comparative study. Most patients had failed multiple treatments. Serial clinical evaluations with individual symptom scores were the primary outcome measure of efficacy. Results: Mean follow up was 2 years (range 4 weeks - 5 years). 14/16 patients on albumin and 4/7 patients on saline infusions improved. Significantly more patients (7 vs. 1) on albumin showed marked improvement from baseline with more prominent reduction in orthostatic heart rate (mean reduction 19 vs. 14 beats minute). Albumin was well tolerated. More patients on saline (3/7 vs. 2/16) discontinued infusions due to lack of efficacy. Some patients required a permanent venous catheter. Conclusions: Intravenous albumin infusions are well tolerated and more effective than normal saline in refractory POTS.

Abstract 116: Antinuclear Antibody levels Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Medical Records ◽  
Antinuclear Antibody ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Autoimmune Reaction ◽  
Autonomic Disturbance ◽  
Antibody Levels

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. An antinuclear antibody (ANA) test measures the amount and pattern of antibodies in blood that work against own body (autoimmune reaction). If there are more antibodies in the blood than normal, the test is positive. The aim of this study is to demonstrate ANA levels in POTS. Methods: 151 patients were selected randomly from our clinic with POTS. Patients ANA levels were reviewed from electronic medical records and performed data analysis. Results: Out of 151 patients, 129 patients are females (85%, n=129, age 32±10.98), 22 patients are males (15%, n=22, age 27.90±12.11). 110/151(73%) patients had negative ANA, 41(27%) patients had positive ANA. Conclusion: Our research results demonstrated that ANA levels are positive in one fourth of Postural Orthostatic Tachycardia Syndrome (POTS) patients.

Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center

2020 ◽  
Vol 35 (8) ◽  
pp. 526-535 ◽  
Author(s):  
Anthony Staples ◽  
Nicolas R. Thompson ◽  
Manikum Moodley
Keyword(s):  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Care Center ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Presenting Symptoms ◽  
Unexplained Pain ◽  
Patient Reported ◽  
Pediatric Onset

Aim: We characterize the pediatric postural orthostatic tachycardia syndrome (POTS) population seen at a single tertiary care referral center. Method: Retrospective chart review of all pediatric POTS patients seen in our center between 2015 and 2017. Pediatric POTS was defined as chronic, at least 3 months, symptoms of orthostatic intolerance associated with excessive orthostatic tachycardia as determined by tilt table testing with orthostatic heart rate increment of ≥40 bpm within 5 minutes of head-up tilt or absolute orthostatic heart rate ≥130 bpm for patients 13 years old and younger and ≥120 bpm for those 14 years and older. We looked at demographics, presenting symptoms, comorbidities, examination findings, investigation findings, treatment, and patient reported outcomes. Outcome measures were separated by patient report and group comparisons were made using 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. Results: One hundred thirty-four patients with pediatric onset POTS were identified. The mean age was 15 years. Seventy-nine percent of patients were female and 90% were white. The most common presenting symptoms included dizziness/lightheadedness (88%), syncope (54%), and palpitations (40%). Many patients had significant comorbidities attributable to numerous bodily systems, most commonly headache syndromes (migraine 43%, nonspecific headache 22%, chronic daily headache 14%, and new daily persistent headache 5%) and chronic fatigue (60%). Low vitamin D and insufficient iron stores were commonly seen. The majority of patients improved or had resolution of symptoms following treatment (70%). When separated by outcome, statistically significant differences were found for glucose (patients whose symptoms resolved had higher median glucose), palpitations (patients whose symptoms resolved were less likely to have palpitations), constipation (patients whose symptoms were stable/worsened were more likely to have constipation), and unexplained pain (patients whose symptoms were stable/worsened were more likely to have unexplained pain). Conclusions: Pediatric POTS is a chronic condition with a fairly good prognosis following appropriate treatment. It is associated with numerous comorbidities that necessitate multidisciplinary expert care.

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