A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy.
OBJECTIVE
To report a case of fatal pulmonary embolism associated with the use of i.v. estrogen therapy for menometrorrhagia.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 52-year-old woman with fibroid uterus treated with GnRH analogues with add-back therapy who presented with excessive vaginal bleeding.


METHODS
Intravenous conjugated estrogens were administered for a total of six doses.


METHODS
Fatal thromboembolic event.


RESULTS
The day after i.v. conjugated estrogens were administered, the patient had only scant vaginal bleeding, but she experienced the sudden onset of respiratory distress, became comatose, and subsequently had ventricular fibrillation leading to asystole. All resuscitative efforts failed. Postmortem examination revealed bilateral pulmonary artery thromboembolism (saddle embolus).


CONCLUSIONS
Intravenous conjugated estrogen therapy may be complicated by fatal thromboembolic events. This potential adverse effect must be considered in the use of such therapy for severe menometrorrhagia, especially when treating a patient at increased risk.
Zreik
T G
TG
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA. tony.zreik@yale.edu
Odunsi
K
K
Cass
I
I
Olive
D L
DL
Sarrel
P
P
D004359:Drug Therapy, Combination; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000139:chemically induced*