From the Guidelines
Hyperandrogenic Postural Orthostatic Tachycardia Syndrome (POTS) is treatable, allowing for significant improvement in physical activity and quality of life, although complete resolution varies by individual. Many patients experience improvement with proper treatment, enabling them to return to sports and normal activities. Treatment typically involves a combination of non-pharmacological approaches and medications, as noted in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
Treatment Approaches
- Beta-blockers like propranolol (10-40mg twice daily) or metoprolol (25-100mg daily) are often prescribed to control heart rate and reduce adrenaline effects.
- Some patients benefit from ivabradine (2.5-7.5mg twice daily) to slow heart rate without affecting blood pressure.
- Fludrocortisone (0.1-0.2mg daily) may help increase blood volume.
- Non-pharmacological approaches are equally important, including:
- Increasing fluid intake (2-3 liters daily)
- Adding 8-10g of salt to the diet
- Wearing compression garments
- Following a graduated exercise program
- Practicing good sleep hygiene
Importance of Physical Reconditioning
Physical reconditioning through a carefully structured exercise program is particularly important for returning to sports, as highlighted in the guidelines 1. The hyperadrenergic form of POTS specifically responds well to treatments targeting the excess adrenaline response. With proper management under healthcare supervision, many patients successfully return to athletic activities and lead fulfilling lives, though some modification of activities may be necessary.
From the Research
Hyperandrogenic Postural Orthostatic Tachycardia Syndrome (POTS) Treatment
- The treatment of hyperandrogenic POTS is not well-established, and there are no standardized treatment protocols known at this time for patients with hyperadrenergic POTS 2.
- Hyperadrenergic POTS patients are usually difficult to treat and are often refractory to most of the first and second line treatments 2.
- Treatment of hyperandrogenic states in general should be according to their etiology, and may include the use of antiandrogen and antigonadotropin drugs such as cyproterone acetate 3.
- In the context of polycystic ovary syndrome (PCOS), a common hyperandrogenic disorder, treatment may include lifestyle modifications, medication such as insulin-sensitizers, and cosmetic procedures 4, 5.
- For congenital adrenal hyperplasia, a condition that may cause hyperandrogenic signs, treatment typically involves dexamethasone 6.
Treatment Goals
- The goal of treatment for hyperandrogenic POTS is to alleviate symptoms of orthostatic intolerance and allow for normal physical activity and quality of life.
- Treatment of hyperandrogenic states, such as PCOS, aims to address the underlying hormonal imbalance and improve symptoms such as hirsutism, acne, and oligomenorrhea 4, 5.
- Individualized treatment approaches may be necessary, as patients with hyperadrenergic POTS may have unique responses to different treatments 2.