Abstract
Puberty is initiated by hormonal changes in the adolescent body that trigger physical and behavioral changes to reach adult maturation. As these changes occur, some adolescents experience concerning pubertal symptoms that are associated with dysfunction of the autonomic nervous system (ANS). Vasovagal syncope (VVS) and Postural Orthostatic Tachycardia Syndrome (POTS) are common disorders of the ANS associated with puberty that are related to orthostatic intolerance and share similar symptoms. Compared to young males, young females have decreased orthostatic tolerance and a higher incidence of VVS and POTS. As puberty is linked to changes in specific sex and non-sex hormones, and hormonal therapy sometimes improves orthostatic symptoms in female VVS patients, it is possible that pubertal hormones play a role in the increased susceptibility of young females to autonomic dysfunction. The purpose of this paper is to review the key hormonal changes associated with female puberty, their effects on the ANS, and their potential role in predisposing some adolescent females to cardiovascular autonomic dysfunctions such as VVS and POTS. Increases in pubertal hormones such as estrogen, thyroid hormones, growth hormone, insulin, and insulin-like growth factor-1 promote vasodilatation and decrease blood volume. This may be exacerbated by higher levels of progesterone, which suppresses catecholamine secretion and sympathetic outflow. Abnormal heart rate increases in POTS patients may be exacerbated by pubertal increases in leptin, insulin, and thyroid hormones acting to increase sympathetic nervous system activity and/or catecholamine levels. Given the coincidental timing of female pubertal hormone surges and adolescent onset of VVS and POTS in young women, coupled with the known roles of these hormones in modulating cardiovascular homeostasis, it is likely that female pubertal hormones play a role in predisposing females to VVS and POTS during puberty. Further research is necessary to confirm the effects of female pubertal hormones on autonomic function, and their role in pubertal autonomic disorders such as VVS and POTS, in order to inform the treatment and management of these debilitating disorders.
Highlights
Puberty Is Associated With Orthostatic IntolerancePuberty is a period of adolescence in which a child undergoes rapid changes that affect physical and mental functioning in order to reach adult maturation
Other physical symptoms can occur at the onset of puberty that reflect autonomic nervous system (ANS) dysfunction, compromising the homeostatic regulation of basic bodily functions (Palma et al, 2017; Table 2)
The most common sub-type of orthostatic syncope associated with puberty is vasovagal syncope (VVS) (Da and da Silva, 2014), responsible for up to 80% of pediatric syncope cases (Massin et al, 2004)
Summary
Puberty is a period of adolescence in which a child undergoes rapid changes that affect physical and mental functioning in order to reach adult maturation. During this time many adolescents experience substantial fatigue, mood swings, and stress (Larson et al, 1980). These symptoms of puberty are well-known and not generally worrisome (Larson et al, 1980; Wheeler, 1991; Viner and Christie, 2005; Table 1).
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