Estradiol valerate/medroxyprogesterone
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Venous and arterial thrombo-embolic complications: case report A 48-year-old male-to-female transgender patient experienced venous and arterial thrombo-embolic complications during treatment with estradiol valerate and medroxyprogesterone. The patient, who had been taking high doses of depot estradiol valerate 30mg every 2 weeks and medroxyprogesterone 150mg every 2 weeks since the age of 16 years, presented with acute onset dyspnoea and collapse. She had central cyanosis, a HR of 150 beats/min and an oxygen saturation of 48%. Her Glasgow Coma Scale score was 8/15. An ECG revealed sinus tachycardia. She had a troponin level of 9.25 ng/mL and arterial blood gas analysis revealed respiratory acidosis and marked hypoxia. Marked global hypokinesis was revealed by transthoracic echocardiography. The patient was treated for acute asthma exacerbation and received SC heparin for pulmonary embolism. A ventilation perfusion scan showed numerous pulmonary infarcts. After 3 days, she self-extubated and was weaned off ionotropes [sic]. She was uninhibited and disorientated to person, place and time; she had nominal dysphasia and right facial palsy. Her right arm power was decreased (4+/5) and her right-sided reflexes were brisk with an extensor right plantar response. She had marked gait apraxia. A brain CT and MRI showed regions of infarction on both frontoparietal and left parietooccipital areas. Bilateral occlusions of her internal carotid arteries were revealed by carotid ultrasound. CT angiography revealed significant collateral supply, which indicated that carotid stenosis was long-lasting. She initially had a poor performance on cognitive function tests (mini-mental score [MMS] 11/30) and executive function tests (frontal assessment battery [FAB] 6/15). She underwent intensive rehabilitation and, by week 3, her cognitive test results had improved (MMS 29/30, FAB 15/15). She was able to walk using a stick and could independently perform daily activities. She was discharged on warfarin and, at latest follow-up, was well. Mullins GM, et al. Venous and arterial thrombo-embolic complications of hormonal treatment in a male-to-female transgender patient. Journal of Clinical 801107167 Neuroscience : Online first, 3 Apr 2008 - Ireland
0114-9954/10/1200-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 3 May 2008 No. 1200
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