Hypothalamic hypopituitarism from "normal pressure" hydrocephalus.

A 67-year-old man took labetalol (Trandate) 400 mg thrice daily and clonidine 0 3 mg daily from June 1977 for hypertension. Methyldopa had been withdrawn because of diarrhoea, and propranolol and clonidine had proved ineffective. Twelve weeks after beginning labetalol he developed an itchy eruption on his penis, which spread to the trunk and limbs. When he attended hospital 10 weeks later the eruption consisted of reddish purple macules and papules, many of which were oval and had a pityriasis-rosea-like distribution on the trunk. On the legs many of the lesions were bullous. Wickham's striae were present on the glans penis, and typical lichen planus lesions were also seen on the limbs. Biopsy of one of the lesions showed an infiltrate of mononuclear cells in the upper dermis associated with liquefactive degeneration of the basal layer and early bulla formation. Some necrotic keratinocytes were present in the epidermis (figure). Labetalol and clonidine were replaced by atenolol and Moduretic. Dilute topical steroids were given for symptomatic relief, but within two days after altering his antihypertensive treatment his symptoms had settled and topical agents were discon-