[I strongly disagree with the treatment.]
Cervi A, Balitsky AK. Testosterone use causing erythrocytosis. CMAJ 2017;189(41):E1286-E8. http://www.cmaj.ca/content/189/41/E1286
Key Points
· Testosterone therapy can cause secondary erythrocytosis.
· Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias.
· A baseline value for hematocrit should be obtained before testosterone therapy is started, and serial values should be taken at 3, 6 and 12 months after initiation of treatment.
· For symptomatic patients with a hematocrit value over 54%, testosterone should be discontinued and phlebotomy considered.
60-year-old man with a medical history of depression, seasonal allergies, remote appendectomy and cholecystectomy presented to the emergency department with a sudden headache.
Upon examination, his blood pressure was elevated (190/112 mm Hg) and he had erythrocytosis (hemoglobin 196 [normal 130–180] g/L and hematocrit 58% [normal 40%– 54%]).
Results for a complete blood cell count that was obtained six months before the patient’s visit to the emergency department were normal (hemoglobin 154 g/L and hematocrit 46%).
Our patient was discharged from the emergency department with a prescription for amlodipine (5 mg once daily) for management of his hypertension.
After follow-up with his family physician, he was referred to our general hematology clinic for evaluation of erythrocytosis.
Cervi A, Balitsky AK. Testosterone use causing erythrocytosis. CMAJ 2017;189(41):E1286-E8. http://www.cmaj.ca/content/189/41/E1286
Key Points
· Testosterone therapy can cause secondary erythrocytosis.
· Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias.
· A baseline value for hematocrit should be obtained before testosterone therapy is started, and serial values should be taken at 3, 6 and 12 months after initiation of treatment.
· For symptomatic patients with a hematocrit value over 54%, testosterone should be discontinued and phlebotomy considered.
60-year-old man with a medical history of depression, seasonal allergies, remote appendectomy and cholecystectomy presented to the emergency department with a sudden headache.
Upon examination, his blood pressure was elevated (190/112 mm Hg) and he had erythrocytosis (hemoglobin 196 [normal 130–180] g/L and hematocrit 58% [normal 40%– 54%]).
Results for a complete blood cell count that was obtained six months before the patient’s visit to the emergency department were normal (hemoglobin 154 g/L and hematocrit 46%).
Our patient was discharged from the emergency department with a prescription for amlodipine (5 mg once daily) for management of his hypertension.
After follow-up with his family physician, he was referred to our general hematology clinic for evaluation of erythrocytosis.
