Pseudotumour cerebri as a side effect of leuprorelin acetate

Leuprorelin acetate is a synthetic nona-peptide analogue of the naturally occurring gonadotrophin releasing hormone LH-RH (hypothalamus), used in the treatment of sterility, endometriosis or prostatic cancer. In a 35 year old woman, treated with leuprorelin acetate, after 5 months treatment, the side-effects (hot flushes, sweating, sleeping disorders), appeared to be rather unbearable. Medication was ended. The endocrine reversion to the normal physiological balance was association with high fever (38.9 degrees C) during an 8 day period. Increasing scotomas resulted in a gradual loss of eyesight in one eye, associated with a normal visual acuity. Unilateral papilloedema was observed, indicating the possibility of tumor cerebri. Fluorescein angiography demonstrated an intense leakage of the right optic disc. No signs of retinal vascular malformations were seen. The eye pressure was normal. No signs of hemorrhages were observed. Visual field examination showed an enlarged blind spot with a few scotomas above the centre of fixation. CT scan of the brain was normal, the cerebrospinal fluid (CSF) was normal, indicated by IgG production. Six months after ending the leuprorelin acetate treatment, the eyesight was spontaneously 100% recovered. It is most likely that leuprorelin acetate is responsible for the emergence of pseudotumor cerebri. As described by Prof. Sidi et al(1), leuprorelin strongly induces increased liquor pressure, being the intermediate mechanism between hormonal treatment and an ante grade mechanical force, on the optic nervus. Because of the risk of permanent loss of eyesight, it is strongly advised to verify eye parameters conscientiously during leuprorelin treatment.