Clinical Autonomic Research

, Volume 20, Issue 2, pp 93–99 | Cite as

Distal sudomotor findings in postural tachycardia syndrome

  • Amanda Catherine Peltier
  • Emily Garland
  • Satish R. Raj
  • Kyoko Sato
  • Bonnie Black
  • Yanna Song
  • Lily Wang
  • Italo Biaggioni
  • Andre Diedrich
  • David Robertson
Research Article

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.

Keywords

Orthostatic intolerance Tachycardia POTS Sudomotor Autonomic neuropathy Sweating 

References

  1. 1.
    Robertson D (1999) The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 317(2):75–77CrossRefPubMedGoogle Scholar
  2. 2.
    Jacob G, Biaggioni I (1999) Idiopathic orthostatic intolerance and postural tachycardia syndromes. Am J Med Sci 317(2):88–101CrossRefPubMedGoogle Scholar
  3. 3.
    Raj SR, Robertson D (2007) Blood volume perturbations in the postural tachycardia syndrome. Am J Med Sci 334(1):57–60CrossRefPubMedGoogle Scholar
  4. 4.
    Vernino S, Low PA, Fealey RD, Stewart JD, Farrugia G, Lennon VA (2000) Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Engl J Med 343(12):847–855CrossRefPubMedGoogle Scholar
  5. 5.
    Schondorf R, Low PA (1993) Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology 43(1):132–137PubMedGoogle Scholar
  6. 6.
    Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M et al (2000) The neuropathic postural tachycardia syndrome. N Engl J Med 343(14):1008–1014CrossRefPubMedGoogle Scholar
  7. 7.
    Thieben MJ, Sandroni P, Sletten DM, rud-Larson LM, Fealey RD, Vernino S et al (2007) Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 82(3):308–313CrossRefPubMedGoogle Scholar
  8. 8.
    Novak V, Novak P, Opfer-Gehrking TL, Low PA (1996) Postural tachycardia syndrome: time frequency mapping. J Auton Nerv Syst 61(3):313–320CrossRefPubMedGoogle Scholar
  9. 9.
    Al-Shekhlee A, Lindenberg JR, Hachwi RN, Chelimsky TC (2005) The value of autonomic testing in postural tachycardia syndrome. Clin Auton Res 15(3):219–222CrossRefPubMedGoogle Scholar
  10. 10.
    Goldstein DS, Eisenhofer G, Stull R, Folio CJ, Keiser HR, Kopin IJ (1988) Plasma dihydroxyphenylglycol and the intraneuronal disposition of norepinephrine in humans. J Clin Invest 81(1):213–220CrossRefPubMedGoogle Scholar
  11. 11.
    Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O’Brien PC, Slezak JM (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20(12):1561–1568CrossRefPubMedGoogle Scholar
  12. 12.
    Diedrich A, Jordan J, Tank J, Shannon JR, Robertson R, Luft FC et al (2003) The sympathetic nervous system in hypertension: assessment by blood pressure variability and ganglionic blockade. J Hypertens 21(9):1677–1686CrossRefPubMedGoogle Scholar
  13. 13.
    (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17(3):354–381Google Scholar
  14. 14.
    Oppenheim AV, Schafer RW (1996) Digital signal processing. Prentice–Hall, New JerseyGoogle Scholar
  15. 15.
    Hoeldtke RD, Davis KM (1991) The orthostatic tachycardia syndrome: evaluation of autonomic function and treatment with octreotide and ergot alkaloids. J Clin Endocrinol Metab 73(1):132–139CrossRefPubMedGoogle Scholar
  16. 16.
    Muenter SN, Charkoudian N, Dotson RM, Suarez GA, Low PA (2005) Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome. Am J Physiol Heart Circ Physiol 289(3):H1226–H1233CrossRefGoogle Scholar
  17. 17.
    Bonyhay I, Freeman R (2004) Sympathetic nerve activity in response to hypotensive stress in the postural tachycardia syndrome. Circulation 110(20):3193–3198CrossRefPubMedGoogle Scholar
  18. 18.
    Goldstein DS, Holmes C, Frank SM, Dendi R, Cannon RO III, Sharabi Y et al (2002) Cardiac sympathetic dysautonomia in chronic orthostatic intolerance syndromes. Circulation 106(18):2358–2365CrossRefPubMedGoogle Scholar
  19. 19.
    Singer W, Spies JM, McArthur J, Low J, Griffin JW, Nickander KK et al (2004) Prospective evaluation of somatic and autonomic small fibers in selected autonomic neuropathies. Neurology 62(4):612–618PubMedGoogle Scholar
  20. 20.
    Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R et al. (1995) Postural tachycardia syndrome (POTS). Neurology 45(4 Suppl 5):S19–S25Google Scholar
  21. 21.
    Khurana RK (1995) Orthostatic intolerance and orthostatic tachycardia: a heterogeneous disorder. Clin Auton Res 5(1):12–18CrossRefPubMedGoogle Scholar
  22. 22.
    Barontini M, Lazzari JO, Levin G, Armando I, Basso SJ (1997) Age-related changes in sympathetic activity: biochemical measurements and target organ responses. Arch Gerontol Geriatr 25(2):175–186CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Amanda Catherine Peltier
    • 1
    • 2
  • Emily Garland
    • 1
    • 3
  • Satish R. Raj
    • 1
    • 3
    • 4
  • Kyoko Sato
    • 5
  • Bonnie Black
    • 1
    • 3
  • Yanna Song
    • 7
  • Lily Wang
    • 7
  • Italo Biaggioni
    • 1
    • 3
    • 4
  • Andre Diedrich
    • 1
    • 3
    • 6
  • David Robertson
    • 1
    • 2
    • 3
    • 4
  1. 1.Autonomic Dysfunction CenterVanderbilt University School of MedicineNashvilleUSA
  2. 2.Department of NeurologyVanderbilt University School of MedicineNashvilleUSA
  3. 3.Department of MedicineVanderbilt University School of MedicineNashvilleUSA
  4. 4.Department of PharmacologyVanderbilt University School of MedicineNashvilleUSA
  5. 5.Department of Clinical PharmacologyTokai University School of MedicineKanagawaJapan
  6. 6.Department of Biomedical EngineeringVanderbilt University School of MedicineNashvilleUSA
  7. 7.Department of BiostatisticsVanderbilt University School of MedicineNashvilleUSA

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