Teen and Adult Onset Dysautonomias: Disorders of Orthostatic Intolerance

Autonomic dysfunction can occur at any age: pediatric, adult, or geriatric. Teen and adult onsets of dysautonomias are considered to be disorders of orthostatic intolerance.

There are more than 70 million people worldwide with dysautonomia. Because there are many forms of dysautonomia, we use the singular term “dysautonomia” to reference autonomic disorders in general or when referring to a specific condition such as orthostatic hypotension (low blood pressure when standing). We use “dysautonomias when referring to many disorders of the autonomic nervous system. 

In teens and adults, dysautonomias usually reflect functional changes in a generally intact autonomic nervous system. This article offers a brief introduction to teen/adult onset dysautonomias. Our article, Understanding Dysautonomia, provides a more thorough review of dysautonomia in general. 

Examples of teen/adult dysautonomias include:

Autonomic Syncope (fainting, transient loss of consciousness) is also called neurally mediated syncope, vasovagal syncope, or neurocardiogenic syncope (NCS). A person with autonomic syncope suffers from frequent episodes of fainting or feelings of faintness/light-headedness. The body overreacts to a trigger (extreme heat, dehydrations, long period of standing, intense pain or emotion), and the blood pressure drops suddenly causing a decrease in the blood flow to the brain. This is one of the most common forms of dysautonomia. This is not a life-threatening condition. Cases can be mild or severe. In more severe cases, patients need to be careful. They may faint multiple times during a day which may cause falls resulting in bone and brain injuries. Not all patients of with autonomic syncope have a history of fainting, but all experience some symptoms of faintness or light-headedness.


Postural Orthostatic Tachycardia (POTS): POTS is characterized by an intolerance for standing up for long periods of time and a rapid pulse rate when standing. It is estimated to impact 1 in every 100 teens. It is more common in women than in men with a 5:1 ratio. It develops more often in adolescents and young adults. The average age of individuals diagnosed with POTS is between 12 and 50. When the autonomic nervous system (ANS) is working as it should, a person stands up and the blood vessels in the lower body constrict. This keeps the blood from pooling in the lower extremities and the gut. This normal reaction of the ANS ensures consistent blood flow to the vital organs including the heart, lungs and brain. In a person with POTS, the blood flow to the brain may decrease and the patient may feel dizzy or light-headed. They may even faint upon standing. And the heartrate increases as the body recognizes this decrease in blood flow.

Dysautonomias affect multiple organ systems.

The autonomic nerves help regulate function in many organ systems.  Therefore, in autonomic disorder, we see symptoms in many organ systems. The organ systems most commonly affected in dysautonomias are the neurological, pulmonary, cardiovascular, urinary, gastrointestinal, secretomotor and pupillomotor.  Because autonomic disorders affect multiple organ systems, the presentation of symptoms are heterogenous, widely varying between different individuals.  For example, one patient with POTS (a common autonomic disorder) may have the chief complaint of abdominal pain while the next POTS patient identifies migraine headaches as their primary symptom.

Dysautonomias in adults often are associated with—and may be secondary to—another disease process or a drug. Common secondary causes include medications, diabetes (diabetic autonomic neuropathy, or DAN), chemotherapy for cancer, irradiation of the neck, and alcoholism. 


Recommended Articles and Tools:


Common Coexisting Conditions

Autonomic Disorders Assessment for Undiagnosed Patients

Autonomic Disorders Assessment for Diagnosed Patients


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