Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents

Pediatrics. 2014 Jan;133(1):e138-42. doi: 10.1542/peds.2012-3427. Epub 2013 Dec 23.


Objective: Vitamin B12 is involved in the production of adrenaline from noradrenaline. It is the cofactor involved in catecholamine degradation and plays a role in myelin synthesis. The current study aimed to investigate the association between vitamin B12 levels and postural orthostatic tachycardia syndrome (POTS) during adolescence when accelerated myelin synthesis increases the vitamin B12 need.

Methods: One hundred twenty-five patients (mean age 11.1 ± 2.3 years; 60% female) reporting short-term loss of consciousness and diagnosed with vasovagal syncope based on anamnesis with a normal distribution and 50 control subjects (mean age 10.94 ± 2.5 years, 62% female) were included in this study. Serum vitamin B12, folic acid, and ferritin levels were measured prospectively in addition to other tests. We defined vitamin B12 deficiency as a serum level <300 pg/mL.(1-4) RESULTS: Vitamin B12 levels were significantly lower in the patient group compared with the control group (47.2% vs 18%, P < .001). In the patient group, children with the POTS pattern had significantly lower vitamin B12 levels compared with children without the POTS response (P = .03).

Conclusions: Vitamin B12 deficiency in patients with POTS may lead to sympathetic nervous system baroreceptor dysfunction.

Keywords: child; postural orthostatic tachycardia syndrome; tilt table test; vasovagal syncope; vitamin B12.

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Postural Orthostatic Tachycardia Syndrome / diagnosis
  • Postural Orthostatic Tachycardia Syndrome / etiology*
  • Prospective Studies
  • Vitamin B 12 / blood
  • Vitamin B 12 Deficiency / blood
  • Vitamin B 12 Deficiency / complications*
  • Vitamin B 12 Deficiency / diagnosis


  • Biomarkers
  • Vitamin B 12