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Distal sudomotor findings in postural tachycardia syndrome

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Abstract

Objectives

Postural tachycardia syndrome (POTS) is a heterogeneous disorder characterized by excessive orthostatic tachycardia in the absence of orthostatic hypotension and by sympathetic nervous system activation. Postganglionic sudomotor deficits have been used to define a neurogenic postural tachycardia POTS subtype. Norepinephrine levels above 600 pg/ml have also been used to delineate patients with a hyperadrenergic state. This study aims to determine the relationship of sudomotor abnormalities to other aspects of dysautonomia in POTS.

Methods

Autonomic function was quantified in thirty women through tests of cardiovagal, adrenergic, and sudomotor function including quantitative sudomotor axon reflex testing (QSART) and spectral indices. Differences between patients with and without sudomotor dysfunction as defined by QSART and between patients with and without hyperadrenergic POTS were assessed with Mann–Whitney U test and Mantel–Haenszel Chi-Square test using a p value of 0.01 for significance. Spearman correlation coefficients were used to test raw sweat volume correlations with other variables.

Results

Of 30 women (ages 20–58), 17 patients (56%) had an abnormal QSART which was typically patchy and involved the lower extremity, while 13 patients had normal QSART results. Other autonomic tests, catecholamines or spectral indices did not correlate with QSART results. No differences in autonomic tests or spectral indices were observed between hyperadrenergic and non-hyperadrenergic POTS.

Interpretation

Our findings confirm that a large subset of POTS patients have sudomotor abnormalities which are typically patchy in distribution but do not correlate with other tests of autonomic function. Further studies are needed to determine the best method of endophenotyping patients with POTS.

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Acknowledgments

This study was funded by the National Institutes of Health NINDS 1K23 NS056009-01A1; P01 HL056693, R01 HL071784, NIH/NCRR K23 RR020783, and by Vanderbilt CTSA grant 1 UL1 RR024975.

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Authors and Affiliations

  1. Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, USA

    Amanda Catherine Peltier, Emily Garland, Satish R. Raj, Bonnie Black, Italo Biaggioni, Andre Diedrich & David Robertson

  2. Department of Neurology, Vanderbilt University School of Medicine, Nashville, USA

    Amanda Catherine Peltier & David Robertson

  3. Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA

    Emily Garland, Satish R. Raj, Bonnie Black, Italo Biaggioni, Andre Diedrich & David Robertson

  4. Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, USA

    Satish R. Raj, Italo Biaggioni & David Robertson

  5. Department of Clinical Pharmacology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Kyoko Sato

  6. Department of Biomedical Engineering, Vanderbilt University School of Medicine, Nashville, USA

    Andre Diedrich

  7. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA

    Yanna Song & Lily Wang

Authors
  1. Amanda Catherine Peltier
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  2. Emily Garland
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  3. Satish R. Raj
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  4. Kyoko Sato
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  5. Bonnie Black
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  6. Yanna Song
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  7. Lily Wang
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  8. Italo Biaggioni
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  9. Andre Diedrich
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  10. David Robertson
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Corresponding author

Correspondence to Amanda Catherine Peltier.

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Peltier, A.C., Garland, E., Raj, S.R. et al. Distal sudomotor findings in postural tachycardia syndrome. Clin Auton Res 20, 93–99 (2010). https://doi.org/10.1007/s10286-009-0045-y

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  • DOI: https://doi.org/10.1007/s10286-009-0045-y

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