When a person with hyperPOTS is upright, there is a loss of plasma blood volume into the surrounding tissue (hypovolemia). Two additional characterizations of hyperPOTS go hand-in-hand - hypovolemia and the reduction in the activity of the enzyme renin and aldosterone. This results in patients having increased norepinephrine (adrenaline) in circulation and a rise in systolic blood pressure upon standing. In other words, symptoms are caused directly from an ANS malfunction, rather than the ANS malfunction being a response to another cause. (Grubb et al, 2011) The mechanism differs from other types in so far as it is caused by centrally driven sympathetic activation. Hyperadrenergic POTS is a subtype of POTS that affects about 10% of patients with dysautonomia symptoms due to orthostatic intolerance.
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