Other Common Symptoms

Not all of the symptoms start right away. It is these other symptoms that can interfere the most with daily life.
Plus, there are other symptoms that can develop that are often associated with failure of the autonomic nervous system. Depending on whether there is a primary autonomic nervous system problem like Parkinson's Disease, these symptoms can sometimes get better as the orthostatic condition improves.

Common Symptoms Related to Autonomic Nervous System Dysfunction

There are a number of other symptoms that people with orthostatic intolerance (OI) can have that are due to autonomic nerve failure.


Symptoms Comments

This refers to the blood vessels and whether they constrict or dilate (get narrower or wider).

Constricted Blood Vessels - in the arms and legs, they can result in cold hands and arms and cold feet.

Dilated vessels - this would be wider vessels that hold more blood. It can cause 'acrocyanosis' or blue legs (see the entry at the bottom of the table)


Too much sweating - hyerhidrosis. If it is local, it is usually the palms and soles (bottoms of the feet).

No sweating. This can cause a problem with dry skin, increase heat (hyperthermia and even vasomotor collapse in hot weather. It's important to keep cool, avoid exposure to heat.

It can happen everywhere or only in regions of the body, like the feet or hands or forehead. (Sudomotor means something that stimulates the sweat glands.)

GI Symptoms

Bloating, nausea, vomiting, pain, constipation, diarrhea

However, in one study, patients with POTS, neurally-mediated hypotension (NMH) or both POTS and NMH had upper GI symptoms. On follow-up, they found that the GI symptoms had improved with improvement in the orthostatic condition.13

Xerostomia - dry mouth.

Other autonomic symptoms not reported as being strongly associated with POTS or NMH: Delayed emptying of the stomach (gastroparesis) - sense of fullness after eating a little bit; problem with swallowing (dysphagia)

Temperature changes

With autonomic dysfunction, there is often a change in the ability to regulate body temperature. A person will overheat when exercising or in hot weather or hot rooms. They can switch and be cold. The person may feel hot inside but the skin on their arms/hands can be cool or cold to the touch. Body temperature or their sense of temperature may be inconsistent with the room temperature. On the other hand, they can be more sensitive to cold and heat. (This is 'peripheral vasomotor dysfunction'14)

Pupil dysfunction (eyes)

Changes in the pupil muscle and accommodation may be present and create symptoms of sensitivity to excessive glare or bright lights or poor night vision.14

Blood pressure fluctuations

The blood pressure is more variable, going up and down, more than it does it in people without POTS.10 There may also be difficulty palpating a pulse at the wrist when a person continues to stand or with the Valsalva maneuver.

Changes in sensation on skin

There may be changes in how the skins feels things.14 There could be areas of increase sensitivity to repeated stimulation of skin. There can a sense of pain from things that do not normally cause pain (allodynia). There could be hyperpathia - which means there is an abnormal increase sense of pain from a stimulus that would be painful, like a pinprick. (autonomic nerve dysfunction)14

Dry eyes, dry mouth, dry skin

These are symptoms of autonomic dysfunction.14

Blue legs

People with POTs or CFS often have a condition called "acrocyanosis" - which means blueness.5,8,10,11, 15  The legs turn colors with standing. These are "acral vasomotor" vasomotor changes due to the failure of the autonomic nervous system (ANS).14  (Changes in the skin due to the blood vessel changes).

They can turn blue (cyanotic) or be pale. They can be pink/red with standing for awhile. But when it is most extreme, they turn blue and the legs swell with standing up for a longer period of time. The blueness or redness could be solid or it might be blotchy (mottled).

The hands can also turn blue with standing up for a while. In some people, when they lie down, the color returns to normal and there is tingling or abnormal sensation until they return to "normal".


Don't see all your symptoms in the lists of Starting, Delayed or Other Symptoms?
Check out the next list - Less Common Autonomic Symptoms


Back to the top

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  14. Gordon, Victor. Assessment of the Autonomic Nervous System in Patients with Neuropathies. Presentation. Faculty of Pain Medicine. Autonomic laboratory, Melbourne Victoria. Assessed July 6, 2012.
  15. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ and Fischer PR. Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatr Neuro 2010; 42:77-85. Abstract.
  16. Capuron L, Welberg L, Heim C, Wagner D, Solomon L, Papanicolaou DA, Craddock RC, Miller AH, Reeves WC. Cognitive dysfunction relates to subjective report of mental fatigue in patients with chronic fatigue syndrome. Psychosom Med. 2008 Sep;70(7):829-36. Epub 2008 Jul 7.Abstract.  Article PDF.

Author: Kay E. Jewell, MD
Page Last Updated: September 5, 2012