Labile Hypertension Responding to Testosterone Withdrawal

Peter D Ambrumenil

doi:10.4172/2167-1095.1000126

Abstract

We report a single case of severe hypertension which presented many challenges in the management and even more in the resolution. Learning Points 1) That there can be unanticipated causes of hypertension 2) That difficult to control blood pressure should cause medical advisers to consider unusual causes of hypertension 3) That hypertension may respond to testosterone withdrawal.

Highlights

The patient initially presented in 2003 at the age of 53 years with a long history of intermittentrecorded high blood pressure readings at incidental measurements, attributed to the ‘white coat’ syndrome
Treatment was instituted with bendroflumethiazide 2.5mg once daily, losartan 100mg once daily plus aspirin 75mg once daily.This treatment resulted in a 24 hour average BP of 117/73mmHg with spikes to 176/116mmHg
The patient was fully investigated with all the conventional tests for hypertension, excluding Conn’s syndrome and a pheochromocytoma. Though his hypertension and endocrine specialist had residual concerns he was seen by an urologist and bilateral orchidectomy was discussed in detail: the patient, a medical practitioner, considered that only removal of his major source of testosterone would normalise his blood pressure, and he accepted orchidectomy in the full knowledge of its possible complications

Summary

Introduction

The patient initially presented in 2003 at the age of 53 years with a long history of intermittentrecorded high blood pressure readings at incidental measurements, attributed to the ‘white coat’ syndrome. In 2003 he presented for a gastroscopy, when his blood pressure was recorded at 270/190mmHg; echocardiography was normal, and there were no ophthalmological signs of hypertension.

Results

Conclusion