The POTScast Dr. Kendal Stewart on a ‘hypo-adrenergic’ variant of POTS, genetics and novel treatments
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Oct 12, 2025 Dr. Kendal Stewart, a former skull-base neurosurgeon turned neuroimmune specialist, dives into the complexities of POTS, especially the hypo-adrenergic variant linked to specific genetic mutations. He emphasizes the importance of genetic testing and nutrigenomics in tailoring treatments, discussing innovative therapies like exosomes and peptides. Dr. Stewart also explores the connection between chronic inflammation, immune modulation, and the role of CBD, providing insight into how these approaches can help manage symptoms effectively.
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POTS As A Neuroimmune Syndrome
- Many POTS cases are syndromes driven by neuroimmune and inflammatory processes rather than single-organ disease.
- Genetics reveal patient-specific drivers and explain diverse POTS presentations.
Hypo‑Adrenergic POTS From DBH Variants
- A common POTS subtype is 'hypoadrenergic' from DBH gene variants that reduce norepinephrine synthesis.
- This explains low standing blood pressure and poor sympathetic vasoconstriction in many patients.
Test Genetics Before Choosing Drugs
- Do get a simple genetic panel to check for DBH and methylation variants to guide POTS treatment.
- Use results to avoid treatments (e.g., beta blockers) that worsen hypoadrenergic patients.