What causes postural orthostatic tachycardia syndrome (POTS)?

Updated: Oct 21, 2018
  • Author: Mohini Gurme, MD; Chief Editor: Selim R Benbadis, MD  more...
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A norepinephrine transporter deficiency has been identified in 1 family. Polymorphisms in genes encoding the beta-2 adrenoreceptor and nitric oxide synthetase may play a role. Beta-receptor supersensitivity, reduced vagal function, brainstem dysfunction, and deficient cerebral blood flow autoregulation are other proposed mechanisms. Some patients have restricted autonomic neuropathy.

Vitamin B12 is involved in catecholamine metabolism, and Oner and colleagues have suggested that vitamin B12 deficiency in adolescents may cause sympathetic baroreceptor dysfunction. In their study of 125 adolescent patients who had suffered a short-term loss of consciousness and had been diagnosed with vasovagal syncope, 47.2% of patients had low vitamin B12 levels, compared with 18% of a group of 50 control subjects, and vitamin B12 levels were significantly lower in those patients diagnosed with POTS than in the other patients. [7, 8]

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