Severe menses-associated hypertension successfully treated with gonadotropin-releasing hormone agonist

A case of a 32-year-old nulliparous white woman referred for a 5-year history of severe hypertension, hypokalemia, and resultant systolic dysfunction is presented. She additionally had a left ventricular ejection fraction of 30% including left ventricular dilation and normal left ventricular mass index, as measured by cardiac magnetic resonance imaging when she initially presented to us. Her history revealed that her severe hypertension episodes were monthly and would occur around the catamenial (menses-associated) time. Two weeks following her menses, blood pressure decreased significantly but remained elevated above 140/90 mm Hg. This cycle repeated monthly and required multiple hospitalizations for hypertensive emergency in the form of acute decompensated heart failure and severe headaches. She required potassium supplementation. This prompted a complete evaluation for secondary causes of hypertension, which was negative. Female and male sex hormone levels, including testosterone, were also within normal limits. She received an injection of leuprolide acetate depot (11.25 mg every 3 months), a gonadotropin-releasing hormone agonist. This significantly reduced the magnitude of these episodes.