Case report
Postural tachycardia syndrome: Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading

https://doi.org/10.1016/0002-9343(82)90559-9Get rights and content

Abstract

A patient with disabling postural tachycardia without postural hypotension had symptoms that included palpitations, weakness, abdominal and leg pain, light-headedness, headache and diaphoresis that occurred only in the upright position. She was shown to have an enhanced sympathetic neural response to standing (exaggerated plasma norepinephrine response), and her cardiovascular responsiveness to released catecholamines was clearly intact. However, she was unable to maintain normal sodium balance and had a measurably reduced plasma volume while consuming normal amounts (120 mmol dally) of dietary sodium. Sodium loading (240 mmol ingested dally plus administration of fluorohydrocortisone, 0.1 mg daily) largely corrected the hemodynamic abnormalities, prevented postural symptoms and caused the compensatory sympathetic response to revert to normal.

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This study was supported in part by U.S. Public Health grants AM 27085, RR00036 and AM 20579.

1

From the Metabolism Division of the Department of Medicine, Washington University School of Medicine, 660 South Euclid, St. Louis, Missouri 63110.

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