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Pseudotumor cerebri in children receiving recombinant human growth hormone
A H Rogers1, G L Rogers, D L Bremer
1Department of Ophthalmology, Boston University School of Medicine, Massachusetts, USA.
Insights
Recombinant human growth hormone (rhGH) may cause pseudotumor cerebri (PTC) in children. Discontinuation of rhGH led to resolution of PTC symptoms, highlighting the need for ophthalmic monitoring in patients receiving rhGH.
Area of Science:
- Ophthalmology
- Pediatrics
- Endocrinology
Background:
- Pseudotumor cerebri (PTC) is a condition of increased intracranial pressure.
- Recombinant human growth hormone (rhGH) is used to treat short stature in children with various genetic syndromes.
Observation:
- This case series reports three children who developed PTC while receiving rhGH therapy.
- Papilledema, a key sign of PTC, was identified during ophthalmic examinations.
Findings:
- Cessation of rhGH treatment resulted in the resolution of papilledema in all three cases.
- Visual acuity outcomes varied, with one child requiring a shunt for persistent intracranial pressure.
- A potential causal relationship between rhGH initiation and PTC development is suggested.
Implications:
- Ophthalmologists should consider rhGH as a potential factor in pediatric PTC cases.
- Children on rhGH therapy experiencing headaches or visual disturbances require prompt ophthalmic evaluation.
- Establishing baseline ophthalmic examinations and routine follow-up is crucial for non-verbal or pre-verbal children.
Purpose:
This article represents the first report in the ophthalmology literature of an association between pseudotumor cerebri (PTC) and recombinant human growth hormone (rhGH).
Design:
Noncomparative case series.
Participants:
Three children receiving rhGH for short stature with Turner syndrome, Jeune syndrome, or Down syndrome.
Methods:
Children underwent full ocular examination. After papilledema was identified, patients underwent lumbar puncture and imaging with either magnetic resonance imaging or computerized tomography. Treatment was under the guidance of the primary physician or neurosurgeon. The rhGH was discontinued in all children.
Main Outcome Measures:
Visual acuity and evaluation of the optic nerve for resolution of papilledema were followed at each examination.
Results:
In all three cases, papilledema resolved with the cessation of rhGH, and treatment with acetazolamide or prednisone. Visual acuity was unchanged in case 1, decreased by two to three lines in case 2, and was inconsistent in case 3. One child (case 2) required a ventriculoperitoneal shunt for persistent elevation of intracranial pressure.
Conclusion:
There appears to be a causal relationship between the initiation of rhGH with the development of PTC. Children should have a complete ophthalmic evaluation if they report headache or visual disturbances. Baseline examination with routine follow-up should be instituted when children cannot adequately communicate.