Pediatric disorders of orthostatic intolerance

Julian M. Stewart*, Jeffrey R. Boris, Gisela Chelimsky, Phillip R. Fischer, John E. Fortunato, Blair P. Grubb, Geoffrey L. Heyer, Imad T. Jarjour, Marvin S. Medow, Mohammed T. Numan, Paolo T. Pianosi, Wolfgang Singer, Sally Tarbell, Thomas C. Chelimsky, The Pediatric Writing Group of the American Autonomic Society

*Corresponding author for this work

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient

Original languageEnglish (US)
Article numbere20171673
JournalPediatrics
Volume141
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Orthostatic Intolerance
Pediatrics
Orthostatic Hypotension
Signs and Symptoms
Postural Orthostatic Tachycardia Syndrome
Vasovagal Syncope
Joint Instability
Bed Rest
Hypovolemia
Immune System Diseases
Posture
Mast Cells
Comorbidity
Weight Loss
Anxiety
Exercise

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stewart, J. M., Boris, J. R., Chelimsky, G., Fischer, P. R., Fortunato, J. E., Grubb, B. P., ... The Pediatric Writing Group of the American Autonomic Society (2018). Pediatric disorders of orthostatic intolerance. Pediatrics, 141(1), [e20171673]. https://doi.org/10.1542/peds.2017-1673
Stewart, Julian M. ; Boris, Jeffrey R. ; Chelimsky, Gisela ; Fischer, Phillip R. ; Fortunato, John E. ; Grubb, Blair P. ; Heyer, Geoffrey L. ; Jarjour, Imad T. ; Medow, Marvin S. ; Numan, Mohammed T. ; Pianosi, Paolo T. ; Singer, Wolfgang ; Tarbell, Sally ; Chelimsky, Thomas C. ; The Pediatric Writing Group of the American Autonomic Society. / Pediatric disorders of orthostatic intolerance. In: Pediatrics. 2018 ; Vol. 141, No. 1.
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title = "Pediatric disorders of orthostatic intolerance",
abstract = "Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40{\%} of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient",
author = "Stewart, {Julian M.} and Boris, {Jeffrey R.} and Gisela Chelimsky and Fischer, {Phillip R.} and Fortunato, {John E.} and Grubb, {Blair P.} and Heyer, {Geoffrey L.} and Jarjour, {Imad T.} and Medow, {Marvin S.} and Numan, {Mohammed T.} and Pianosi, {Paolo T.} and Wolfgang Singer and Sally Tarbell and Chelimsky, {Thomas C.} and {The Pediatric Writing Group of the American Autonomic Society}",
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Stewart, JM, Boris, JR, Chelimsky, G, Fischer, PR, Fortunato, JE, Grubb, BP, Heyer, GL, Jarjour, IT, Medow, MS, Numan, MT, Pianosi, PT, Singer, W, Tarbell, S, Chelimsky, TC & The Pediatric Writing Group of the American Autonomic Society 2018, 'Pediatric disorders of orthostatic intolerance', Pediatrics, vol. 141, no. 1, e20171673. https://doi.org/10.1542/peds.2017-1673

Pediatric disorders of orthostatic intolerance. / Stewart, Julian M.; Boris, Jeffrey R.; Chelimsky, Gisela; Fischer, Phillip R.; Fortunato, John E.; Grubb, Blair P.; Heyer, Geoffrey L.; Jarjour, Imad T.; Medow, Marvin S.; Numan, Mohammed T.; Pianosi, Paolo T.; Singer, Wolfgang; Tarbell, Sally; Chelimsky, Thomas C.; The Pediatric Writing Group of the American Autonomic Society.

In: Pediatrics, Vol. 141, No. 1, e20171673, 01.01.2018.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Pediatric disorders of orthostatic intolerance

AU - Stewart, Julian M.

AU - Boris, Jeffrey R.

AU - Chelimsky, Gisela

AU - Fischer, Phillip R.

AU - Fortunato, John E.

AU - Grubb, Blair P.

AU - Heyer, Geoffrey L.

AU - Jarjour, Imad T.

AU - Medow, Marvin S.

AU - Numan, Mohammed T.

AU - Pianosi, Paolo T.

AU - Singer, Wolfgang

AU - Tarbell, Sally

AU - Chelimsky, Thomas C.

AU - The Pediatric Writing Group of the American Autonomic Society

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient

AB - Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient

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U2 - 10.1542/peds.2017-1673

DO - 10.1542/peds.2017-1673

M3 - Review article

VL - 141

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

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ER -

Stewart JM, Boris JR, Chelimsky G, Fischer PR, Fortunato JE, Grubb BP et al. Pediatric disorders of orthostatic intolerance. Pediatrics. 2018 Jan 1;141(1). e20171673. https://doi.org/10.1542/peds.2017-1673