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The hyper activation of HPA axis stimulate overproduction of cortisol, while down regulation of HPG axis results in the production of subnormal levels of gonadotropic hormones

This can cause fatigue, pale skin, and shortness of breath, as the body struggles to transport oxygen efficiently

[DOI] [PMC free article] [PubMed] [Google Scholar] 109.Chen B., Dowlatshahi D., MacQueen G.M., Wang J.F., Young L.T

Four clusters of patients were identified in this study, characterized by 1) multisystemic symptomatology, 2) POTS-dominant presentation, 3) cognitive and sleep dysfunction with increased pain, and 4) milder symptomatology (Fig