Document Detail

Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders.
MedLine Citation:
PMID:  15710782     Owner:  NLM     Status:  MEDLINE    
Postural tachycardia syndrome (POTS) is a disabling condition that commonly affects otherwise normal young females. Because these patients can present with a flushing disorder, we hypothesized that mast cell activation (MCA) can contribute to its pathogenesis. Here we describe POTS patients with MCA (MCA+POTS), diagnosed by episodes of flushing and abnormal increases in urine methylhistamine, and compared them to POTS patients with episodic flushing but normal urine methylhistamine and to normal healthy age-matched female controls. MCA+POTS patients were characterized by episodes of flushing, shortness of breath, headache, lightheadedness, excessive diuresis, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. Triggering events include long-term standing, exercise, premenstrual cycle, meals, and sexual intercourse. In addition, patients were disabled by orthostatic intolerance and a characteristic hyperadrenergic response to posture, with orthostatic tachycardia (from 79+/-4 to 114+/-6 bpm), increased systolic blood pressure on standing (from 117+/-5 to 126+/-7 mm Hg versus no change in POTS controls), increased systolic blood pressure at the end of phase II of the Valsalva maneuver (157+/-12 versus 117+/-9 in normal controls and 119+/-7 mm Hg in POTS; P=0.048), and an exaggerated phase IV blood pressure overshoot (50+/-10 versus 17+/-3 mm Hg in normal controls; P<0.05). In conclusion, MCA should be considered in patients with POTS presenting with flushing. These patients often present with a typical hyperadrenergic response, but beta-blockers should be used with great caution, if at all, and treatment directed against mast cell mediators may be required.
Cyndya Shibao; Carmen Arzubiaga; L Jackson Roberts; Satish Raj; Bonnie Black; Paul Harris; Italo Biaggioni
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2005-02-14
Journal Detail:
Title:  Hypertension     Volume:  45     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-02-25     Completed Date:  2005-10-25     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  385-90     Citation Subset:  IM    
Division of Clinical Pharmacology, Department of Medicine and Pharmacology, and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, Tenn 37212, USA.
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects,  therapeutic use
Autonomic Nervous System / physiopathology*
Case-Control Studies
Histamine H1 Antagonists / therapeutic use
Histamine H2 Antagonists / therapeutic use
Hypotension, Orthostatic / drug therapy,  physiopathology*
Mast Cells*
Methyldopa / therapeutic use
Sympatholytics / therapeutic use
Tachycardia / drug therapy,  physiopathology*
Grant Support
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Histamine H1 Antagonists; 0/Histamine H2 Antagonists; 0/Sympatholytics; 555-30-6/Methyldopa
Comment In:
Hypertension. 2005 Mar;45(3):354-5   [PMID:  15710781 ]

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