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Benign intracranial hypertension following corticosteroid withdrawal in childhood
Insights
Reducing corticosteroid or corticotrophin dosage in children with various diseases can lead to a syndrome resembling benign intracranial hypertension. Dosage reduction duration and rate are key factors in developing this condition.
Area of Science:
- Pediatric Neurology
- Endocrinology
- Ophthalmology
Background:
- Corticosteroids and corticotrophin are widely used in treating various pediatric diseases.
- Abrupt or rapid reduction of these medications can precipitate adverse effects.
- Benign intracranial hypertension (BIH) is a condition characterized by increased intracranial pressure without a clear cause.
Purpose of the Study:
- To identify and describe a syndrome in children mimicking benign intracranial hypertension following corticosteroid or corticotrophin dosage reduction.
- To explore potential contributing factors to the development of this syndrome.
Main Methods:
- Observational study over an 18-month period.
- Clinical case review of seven children who developed the syndrome.
- Analysis of corticosteroid/corticotrophin dosage reduction parameters (duration, rate).
Main Results:
- Seven children developed a syndrome indistinguishable from benign intracranial hypertension after their corticosteroid or corticotrophin dosage was reduced.
- The duration and rate of dosage reduction appeared to be significant factors.
- An underlying susceptibility to cerebral edema may also play a role.
Conclusions:
- Dosage reduction of corticosteroids or corticotrophin in children can induce a BIH-like syndrome.
- Careful consideration of reduction protocols and patient susceptibility is warranted.
- Mild forms may be underdiagnosed; further research into pathogenesis is needed.
Abstract:
In an 18-month period seven children who were treated for a variety of neurological and non-neurological diseases, and in whom the corticosteroid or corticotrophin dosage was reduced, developed a syndrome indistinguishable from "benign intracranial hypertension." The total duration and rate of reduction of corticosteroid dosage and perhaps an underlying susceptibility to cerebral oedema appear to be important factors in this syndrome. Usually patients can be treated without the need for special neuroradiological studies. Possibly mild forms of this condition are not uncommon, but its pathogenesis is still uncertain.