Okamoto, Luis E, Raj, Satish R, Peltier, Amanda et al. · Clinical science (London, England : 1979) · 2012 · DOI
This study looked at patients with POTS (a condition where heart rate increases too much when standing) to see how many also have ME/CFS and whether they are different from POTS patients without ME/CFS. The researchers found that most POTS patients experience severe fatigue, and about two-thirds also meet ME/CFS criteria. Those with both conditions had stronger heart rate increases when standing and signs of greater stress hormone activity.
This research clarifies the relationship between ME/CFS and POTS, two frequently co-occurring conditions that are often misunderstood. By identifying increased sympathetic nervous system activation in CFS-POTS patients, it suggests potential treatment targets (sympathetic modulation) that could benefit patients with both conditions.
This study does not establish that sympathetic hyperactivation *causes* the fatigue or ME/CFS symptoms—only that these markers are associated. The cross-sectional design cannot determine whether CFS-POTS represents a truly distinct entity or merely the severe end of the POTS spectrum. The findings do not explain why some POTS patients develop ME/CFS while others do not.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Okamoto, Luis E, Raj, Satish R, Peltier, Amanda, Gamboa, Alfredo, Shibao, Cyndya, Diedrich, André, et al. (2012). Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.. Clinical science (London, England : 1979). https://doi.org/10.1042/CS20110200
BibTeX
@article{mecfsatlas-okamoto-2012-neurohumoral-haemodynamic,
author = {Okamoto, Luis E and Raj, Satish R and Peltier, Amanda and Gamboa, Alfredo and Shibao, Cyndya and Diedrich, André and Black, Bonnie K and Robertson, David and Biaggioni, Italo},
title = {Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.},
journal = {Clinical science (London, England : 1979)},
year = {2012},
doi = {10.1042/CS20110200},
note = {PubMed: 21906029},
url = {https://www.mecfsatlas.com/evidence/okamoto-2012-neurohumoral-haemodynamic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/okamoto-2012-neurohumoral-haemodynamic
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