{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:49:14Z","timestamp":1776926954620,"version":"3.51.2"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>One hundred twenty-five patients (mean age 11.1 \u00b1 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 \u00b1 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 &amp;lt;300 pg\/mL.1\u20134<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Vitamin B12 levels were significantly lower in the patient group compared with the control group (47.2% vs 18%, P &amp;lt; .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).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Vitamin B12 deficiency in patients with POTS may lead to sympathetic nervous system baroreceptor dysfunction.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2012-3427","type":"journal-article","created":{"date-parts":[[2013,12,24]],"date-time":"2013-12-24T03:54:42Z","timestamp":1387857282000},"page":"e138-e142","source":"Crossref","is-referenced-by-count":31,"title":["Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents"],"prefix":"10.1542","volume":"133","author":[{"given":"Taliha","family":"\u00d6ner","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baris","family":"Guven","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedide","family":"Tavli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timur","family":"Mese","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat Muhtar","family":"Y\u0131lmazer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savas","family":"Demirpence","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Dr. Beh\u00e7et Uz Children\u2019s Hospital, Alsancak, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2014,1,1]]},"reference":[{"issue":"1","key":"2021120819591044000_B1","first-page":"7","volume":"44","author":"Gao","year":"2006","journal-title":"Zhonghua Er Ke Za Zhi."},{"issue":"4","key":"2021120819591044000_B2","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.juro.2007.11.089","article-title":"Ileal enterocystoplasty and B12 deficiency in pediatric patients.","volume":"179","author":"Rosenbaum","year":"2008","journal-title":"J Urol"},{"issue":"9","key":"2021120819591044000_B3","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1007\/s00259-002-0854-x","article-title":"Gastric emptying in patients with vitamin B(12) deficiency.","volume":"29","author":"Ya\u011fci","year":"2002","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"1","key":"2021120819591044000_B4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.pediatrneurol.2011.01.019","article-title":"Retrospective approach to methylenetetrahydrofolate reductase mutations in children.","volume":"45","author":"\u00d6zer","year":"2011","journal-title":"Pediatr Neurol"},{"issue":"9 pt 1","key":"2021120819591044000_B5","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1111\/j.1540-8159.1997.tb04238.x","article-title":"The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing.","volume":"20","author":"Grubb","year":"1997","journal-title":"Pacing Clin Electrophysiol"},{"issue":"5","key":"2021120819591044000_B6","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/BF02281110","article-title":"Vascular responses to orthostatic stress in patients with postural tachycardia syndrome (POTS), in patients with low orthostatic tolerance, and in asymptomatic controls.","volume":"10","author":"Bush","year":"2000","journal-title":"Clin Auton Res"},{"issue":"1","key":"2021120819591044000_B7","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2006-2759","article-title":"Abnormal thermoregulatory responses in adolescents with chronic fatigue syndrome: relation to clinical symptoms.","volume":"120","author":"Wyller","year":"2007","journal-title":"Pediatrics"},{"issue":"2","key":"2021120819591044000_B8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1651-2227.2010.02072.x","article-title":"Polymorphisms of adrenergic cardiovascular control genes are associated with adolescent chronic fatigue syndrome.","volume":"100","author":"Sommerfeldt","year":"2011","journal-title":"Acta Paediatr"},{"issue":"8950","key":"2021120819591044000_B9","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/S0140-6736(95)90525-1","article-title":"Is neurally mediated hypotension an unrecognised cause of chronic fatigue?","volume":"345","author":"Rowe","year":"1995","journal-title":"Lancet"},{"issue":"4","key":"2021120819591044000_B10","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF02267785","article-title":"Neurally mediated hypotension and autonomic dysfunction measured by heart rate variability during head-up tilt testing in children with chronic fatigue syndrome.","volume":"8","author":"Stewart","year":"1998","journal-title":"Clin Auton Res"},{"issue":"5","key":"2021120819591044000_B11","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1172\/JCI114878","article-title":"Pathogenesis of hyperadrenergic orthostatic hypotension. Evidence of disordered venous innervation exclusively in the lower limbs.","volume":"86","author":"Streeten","year":"1990","journal-title":"J Clin Invest"},{"issue":"6","key":"2021120819591044000_B12","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1136\/jnnp.66.6.804a","article-title":"Autonomic dysfunction and orthostatic hypotention caused by vitamin B12 deficiency.","volume":"66","author":"Toru","year":"1999","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"3","key":"2021120819591044000_B13","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s10286-005-0274-7","article-title":"Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients.","volume":"15","author":"Sanya","year":"2005","journal-title":"Clin Auton Res"},{"issue":"6","key":"2021120819591044000_B14","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1212\/01.WNL.0000080365.95436.B8","article-title":"Fatigue in MS is related to sympathetic vasomotor dysfunction.","volume":"61","author":"Flachenecker","year":"2003","journal-title":"Neurology"},{"issue":"5","key":"2021120819591044000_B15","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1111\/j.1540-8159.1992.tb06840.x","article-title":"The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents.","volume":"15","author":"Grubb","year":"1992","journal-title":"Pacing Clin Electrophysiol"},{"issue":"4","key":"2021120819591044000_B16","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1542\/peds.93.4.660","article-title":"Evaluation of recurrent pediatric syncope: role of tilt table testing.","volume":"93","author":"Strieper","year":"1994","journal-title":"Pediatrics"},{"issue":"4","key":"2021120819591044000_B17","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s00246-003-0513-4","article-title":"Association of clinical characteristics of unexplained syncope with the outcome of head-up tilt tests in children.","volume":"25","author":"Qingyou","year":"2004","journal-title":"Pediatr Cardiol"},{"issue":"1","key":"2021120819591044000_B18","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1053\/eupc.1999.0064","article-title":"New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study.","volume":"2","author":"Brignole","year":"2000","journal-title":"Europace"},{"issue":"2","key":"2021120819591044000_B19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/BF02505089","article-title":"Head-up tilt test: a highly sensitive, specific test for children with unexplained syncope.","volume":"17","author":"Alehan","year":"1996","journal-title":"Pediatr Cardiol"},{"issue":"11","key":"2021120819591044000_B20","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/j.1532-5415.1992.tb01801.x","article-title":"Recurrent unexplained syncope in the elderly: the use of head-upright tilt table testing in evaluation and management.","volume":"40","author":"Grubb","year":"1992","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"2021120819591044000_B21","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/0735-1097(96)00236-7","article-title":"Tilt table testing for assessing syncope.","volume":"28","author":"Benditt","year":"1996","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"2021120819591044000_B22","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/0735-1097(92)90517-Q","article-title":"Methodology of isoproterenol-tilt table testing in patients with syncope.","volume":"19","author":"Sheldon","year":"1992","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"2021120819591044000_B23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/nure.12001","article-title":"How prevalent is vitamin B(12) deficiency among vegetarians?","volume":"71","author":"Pawlak","year":"2013","journal-title":"Nutr Rev"},{"issue":"9","key":"2021120819591044000_B24","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1001\/archpedi.160.9.933","article-title":"Obese children and adolescents: a risk group for low vitamin B12 concentration.","volume":"160","author":"Pinhas-Hamiel","year":"2006","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"6","key":"2021120819591044000_B25","first-page":"714","article-title":"Influence of nutritional variables and obesity on health and metabolism.","volume":"58","author":"Azevedo","year":"2012","journal-title":"Rev Assoc Med Bras"},{"issue":"1","key":"2021120819591044000_B26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0301-2115(02)00371-8","article-title":"Serum folate and Vitamin B12 levels in women using modern oral contraceptives (OC) containing 20 microg ethinyl estradiol.","volume":"107","author":"S\u00fctterlin","year":"2003","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"2021120819591044000_B27","doi-asserted-by":"crossref","first-page":"21","DOI":"10.7869\/tg.2012.4","article-title":"Long-term medical management of gastro-esophageal reflux disease: how long and when to consider surgery?","volume":"33","author":"Venkataraman","year":"2012","journal-title":"Trop Gastroenterol"},{"key":"2021120819591044000_B28","doi-asserted-by":"crossref","first-page":"62","DOI":"10.7150\/ijms.7.62","article-title":"Autonomic dysfunction presenting as postural orthostatic tachycardia syndrome in patients with multiple sclerosis.","volume":"7","author":"Kanjwal","year":"2010","journal-title":"Int J Med Sci"},{"issue":"1","key":"2021120819591044000_B29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1566-0702(01)00393-9","article-title":"Autonomic dysfunction and hemodynamics in vitamin B12 deficiency.","volume":"97","author":"Beitzke","year":"2002","journal-title":"Auton Neurosci"},{"issue":"2","key":"2021120819591044000_B30","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1600-0404.1994.tb01645.x","article-title":"Neurologic complications of anorexia nervosa.","volume":"89","author":"Patchell","year":"1994","journal-title":"Acta Neurol Scand"},{"issue":"2","key":"2021120819591044000_B31","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s10286-004-0179-x","article-title":"Syncope, falls and cobalamin deficiency in the old population.","volume":"14","author":"Skrabal","year":"2004","journal-title":"Clin Auton Res"},{"issue":"6","key":"2021120819591044000_B32","first-page":"1105","article-title":"Autonomic function and child chronic fatigue syndrome [in Japanese]","volume":"65","author":"Tanaka","year":"2007","journal-title":"Nihon Rinsho"},{"issue":"4","key":"2021120819591044000_B33","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s10286-002-0014-1","article-title":"Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome.","volume":"12","author":"Timmers","year":"2002","journal-title":"Clin Auton Res"},{"issue":"6","key":"2021120819591044000_B34","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00421-007-0634-1","article-title":"Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome.","volume":"102","author":"Wyller","year":"2008","journal-title":"Eur J Appl Physiol"},{"issue":"2","key":"2021120819591044000_B35","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1203\/00006450-200008000-00016","article-title":"Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion.","volume":"48","author":"Stewart","year":"2000","journal-title":"Pediatr Res"},{"issue":"1","key":"2021120819591044000_B36","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1542\/peds.103.1.116","article-title":"Orthostatic intolerance in adolescent chronic fatigue syndrome.","volume":"103","author":"Stewart","year":"1999","journal-title":"Pediatrics"},{"issue":"5","key":"2021120819591044000_B37","first-page":"501","article-title":"Vitamin B12 and chronic fatigue [in Swedish]","volume":"97","author":"H\u00e4ggl\u00f6f","year":"2000","journal-title":"Lakartidningen"},{"key":"2021120819591044000_B38"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/133\/1\/e138\/1100763\/peds_2012-3427.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/133\/1\/e138\/1100763\/peds_2012-3427.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T15:01:52Z","timestamp":1647788512000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/133\/1\/e138\/68298\/Postural-Orthostatic-Tachycardia-Syndrome-POTS-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,1]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2014,1,1]]},"published-print":{"date-parts":[[2014,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-3427","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,1]]}}}