A 38 year old woman with hypotensive shock at the onset of menstruation: case progression

doi:10.1136/bmj.b246

Published 16 February 2009, doi:10.1136/bmj.b246
Cite this as: BMJ 2009;338:b246

Practice

A 38 year old woman with hypotensive shock at the onset of menstruation: case progression

Sergio Serrano Villar, resident in internal medicine¹, Juncal Perez-Somarriba, consultant in internal medicine ¹, Talia Sainz Costa, resident in paediatrics¹, Sarah Winstanley, foundation doctor², Tomas Santillana Lopez, consultant in internal medicine¹, Luis Escribano Mora, consultant in haematology³, Baltasar Orejas Gonzalez, professor in internal medicine¹

¹ Hospital Clinico San Carlos, Madrid 28040, Spain, ² Kingston Hospital, London, ³ Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain

Correspondence to: S Serrano Villar sergio1serrano@yahoo.es

The first 150 words of the full text of this article appear below.

Last week (BMJ 2009;338 doi:10.1136/bmj.b6) we presented thecase of a 38 year old woman who collapsed from hypotensive shocktriggered by the onset of menstruation and which responded toa steroid bolus. She was admitted to the internal medicine departmentwith suspected adrenal insufficiency. At the time of the admissionshe was stable. She had been well until six months before, whenshe had presented with a similar but less serious syncopal episodecoinciding with abdominal pain and menstruation which resolvedwith fluid replacement. She reported some episodes of diarrhoeatogether with short episodes of purple-red discolouration ofthe neck and face, sweating, and feeling warm.

She had been referred to a gynaecologist for dysmenorrhoea twomonths previously and had started treatment with ethinylestradioland cyproterone acetate, which was her only current medication.She was born in Spain and had never travelled abroad. Her parentswere . . . [Full text of this article]

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