Perspectives: We report a novel syndrome of chronic hyperadrenergic orthostatic intolerance associated with episodes of MCA. This syndrome should be considered in POTS patients with a history of flushing. This symptom is often not volunteered by patients and may require careful questioning by the physician. Diagnosis requires biochemical documentation of MCA because other causes of flushing can be associated with POTS. A correct diagnosis is important because the presence of MCA mandates a different approach in the treatment of these patients. Beta-Blockers, a commonly used therapeutic option in POTS patients, should be used with caution, if at all, because of the risk of triggering MCA. These patients can be treated with H1/H2 histamine antagonist and central sympatholytics.