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Papilledema in 15 renally compromised patients treated with growth hormone
E A Koller1, B V Stadel, S N Malozowski
1Division of Endocrinology and Metabolism, Food and Drug Administration, Rockville, Maryland 20857, USA.
Insights
Growth hormone treatment in renal patients can cause intracranial hypertension, a condition marked by increased pressure around the brain. Monitoring for symptoms is crucial, as the condition often resolves after discontinuing growth hormone therapy.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Neurology
Background:
- Intracranial hypertension (IH) with papilledema is rarely reported in renal patients.
- Growth hormone (GH) therapy is used for impaired growth in children with renal disorders.
Purpose of the Study:
- To report cases of intracranial hypertension in renal patients treated with growth hormone.
- To investigate the relationship between growth hormone therapy and intracranial hypertension in this population.
Main Methods:
- Retrospective review of 15 patients with renal disorders treated with GH who developed IH.
- Analysis of patient demographics, treatment duration, symptoms, and response to GH discontinuation.
Main Results:
- 15 of ~1,670 renal patients developed IH during GH treatment (median age 12 years, M:F 6.5:1).
- Median time to IH onset was 13 weeks; most patients were symptomatic.
- IH symptoms resolved upon GH discontinuation and recurred in some upon re-exposure.
Conclusions:
- Growth hormone therapy may precipitate intracranial hypertension in renal patients, even those with predisposing factors.
- Prospective funduscopic evaluation is recommended for renal patients receiving GH therapy.
- Discontinuation of GH therapy is effective in resolving IH symptoms.
Abstract:
Intracranial hypertension with papilledema has been reported in renal patients, but a survey of the literature suggests that the incidence rate is low. We present reports of 15 of approximately 1,670 patients with renal disorders, who were treated with growth hormone for impaired growth and subsequently developed symptoms and/or signs of intracranial hypertension. The male:female ratio was 6.5:1, and the median age was 12 years. The median duration of growth hormone treatment before onset of symptoms or signs was 13 weeks. All but 2 patients were symptomatic. In the patients in whom growth hormone therapy is known to have been discontinued, the symptoms and signs of intracranial hypertension abated. At least 4 of these patients experienced a recurrence when re-exposed to growth hormone. Many of the affected patients presented with predisposing conditions, but growth hormone appears to have been the precipitating factor. Prospective funduscopic evaluation may be warranted in patients with renal disorders who are receiving growth hormone.