Treatment of Refractory Postural Tachycardia Syndrome with Subcutaneous Octreotide Delivered Using an Insulin Pump

Khan, Muhammad Arif; Ouyang, Jing; Perkins, Karen; Somauroo, John; Joseph, Franklin

doi:10.1155/2015/545029

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…In specialized centers, patients with significant postprandial tachycardia are occasionally treated with octreotide, a somatostatin analog, used to reduce splanchnic pooling. 73 , 74 However, the need for subcutaneous or intramuscular administration, as well as the cost and side effect profile of octreotide have limited its use. A small case series on sinus node modification has found no significant benefits.…”

Section: Approach To Therapy For Patients With Potsmentioning

confidence: 99%

Postural tachycardia syndrome: current perspectives

Wells

Spurrier²,

Linz

et al. 2017

VHRM

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Postural tachycardia syndrome (POTS) is the combination of an exaggerated heart rate response to standing, in association with symptoms of lightheadedness or pre-syncope that improve when recumbent. The condition is often associated with fatigue and brain fog, resulting in significant disruptions at a critical time of diagnosis in adolescence and young adulthood. The heterogeneity of the underlying pathophysiology and the variable response to therapeutic interventions make management of this condition challenging for both patients and physicians alike. Here, we aim to review the factors and mechanisms that may contribute to the symptoms and signs of POTS and to present our perspectives on the clinical approach toward the diagnosis and management of this complex syndrome.

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Section: Approach To Therapy For Patients With Potsmentioning

confidence: 99%

Postural tachycardia syndrome: current perspectives

Wells

Spurrier²,

Linz

et al. 2017

VHRM

View full text Add to dashboard Cite

show abstract

“…The clinical significance of POTS is increasingly appreciated due to the recent reports regarding the comorbidities of POTS, such as depression [1], sleep disorders [6], chronic fatigue syndrome [7], and diminished quality of life (QOL) [6,8]. While the long-term prognosis of POTS has not been investigated well, some patients suffer from refractory POTS [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial

et al. 2018

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“…Among them, eating smalls meals throughout the day and the extremely empirical use of the somatostatin analogue, octreotide, that suppresses the secretion of all vasodilatory peptides but the risk of inducing malabsorption syndrome. 7,8 These interventions, however, are not supported by any robust scientific evidence. Therefore, understanding the pathophysiology behind the worsening postprandial symptoms in POTS, with the goal of developing targeted therapies, is of the utmost importance.…”

mentioning

confidence: 99%

Worsening Postural Tachycardia Syndrome Is Associated With Increased Glucose-Dependent Insulinotropic Polypeptide Secretion

et al. 2022

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Background: Postural tachycardia syndrome (POTS) is characterized by excessive upright tachycardia and disabling presyncopal symptoms, which are exacerbated after consuming a high-carbohydrate meal; it is unknown, however, what is the precise underlying mechanism. We seek to investigate the effect of glucose intake on orthostatic hemodynamic changes and gastrointestinal hormone secretion in POTS. Methods: Prospective, case-control study, 12 women with POTS who reported a postprandial worsening of their POTS symptoms and 13 age-matched female controls received 75-g oral glucose and 20 mg/kg acetaminophen to assess nutrient absorption. Hemodynamic, gastrointestinal hormone and acetaminophen levels were measured for up to 120 minutes postingestion while supine and standing. Results: Patients with POTS had significant orthostatic tachycardia, 48.7±11.2 versus 23.3±8.1 bpm, P =0.012 and elevated upright norepinephrine levels, 835.2±368.4 versus 356.9±156.7 pg/mL, P =0.004. After oral glucose, upright heart rate significantly increased in POTS, 21.2±11.9% versus 6.0±19.9%, P =0.033 with a concomitant decline in upright stroke volume, −10.3±11.90% versus 3.3±13.7%, P =0.027; total peripheral resistance, blood pressure and cardiac output remained unaltered. Acetaminophen rate of appearance was similar between groups ( P =0.707), indicating comparable nutrient absorption rates. POTS had increased plasma levels of C-peptide ( P =0.001), GIP (glucose-dependent insulinotropic polypeptide; P =0.001), peptide YY ( P =0.016), and pancreatic polypeptide ( P =0.04) following glucose consumption, but only GIP had a time-dependent association with the worsening upright tachycardia and stroke volume fall. Conclusions: The glucose-induced worsening orthostatic tachycardia in POTS was associated with a decline in SV; these changes occurred while GIP, a splanchnic vasodilator, was maximally elevated.

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Treatment of Refractory Postural Tachycardia Syndrome with Subcutaneous Octreotide Delivered Using an Insulin Pump

Cited by 7 publications

References 11 publications

Postural tachycardia syndrome: current perspectives

Postural tachycardia syndrome: current perspectives

Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial

Worsening Postural Tachycardia Syndrome Is Associated With Increased Glucose-Dependent Insulinotropic Polypeptide Secretion

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