Practice

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

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b246 (Published 16 February 2009) Cite this as: BMJ 2009;338:b246
  1. Sergio Serrano Villar, resident in internal medicine1,
  2. Juncal Perez-Somarriba, consultant in internal medicine 1,
  3. Talia Sainz Costa, resident in paediatrics1,
  4. Sarah Winstanley, foundation doctor2,
  5. Tomas Santillana Lopez, consultant in internal medicine1,
  6. Luis Escribano Mora, consultant in haematology3,
  7. Baltasar Orejas Gonzalez, professor in internal medicine1
  1. 1Hospital Clinico San Carlos, Madrid 28040, Spain
  2. 2Kingston Hospital, London
  3. 3Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain
  1. Correspondence to: S Serrano Villar sergio1serrano{at}yahoo.es
  • Accepted 7 October 2008

Last week (BMJ 2009;338 doi:10.1136/bmj.b6) we presented the case of a 38 year old woman who collapsed from hypotensive shock triggered by the onset of menstruation and which responded to a steroid bolus. She was admitted to the internal medicine department with suspected adrenal insufficiency. At the time of the admission she was stable. She had been well until six months before, when she had presented with a similar but less serious syncopal episode coinciding with abdominal pain and menstruation which resolved with fluid replacement. She reported some episodes of diarrhoea together with short episodes of purple-red discolouration of the neck and face, …

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