Pseudotumor cerebri in children receiving recombinant human growth hormone.
OBJECTIVE
This article represents the first report in the ophthalmology literature of an association between pseudotumor cerebri (PTC) and recombinant human growth hormone (rhGH).


METHODS
Noncomparative case series.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Rogers
A H
AH
Department of Ophthalmology, Boston University School of Medicine, Massachusetts, USA.
Rogers
G L
GL
Bremer
D L
DL
McGregor
M L
ML
D000293:Adolescent; D001238:Asphyxia Neonatorum / Q000150:complications; D002648:Child; D004314:Down Syndrome / Q000150:complications; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy; D019382:Human Growth Hormone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007427:Intracranial Pressure; D008297:Male; D010009:Osteochondrodysplasias / Q000150:complications; D010211:Papilledema / Q000139:chemically induced / Q000175:diagnosis; D011559:Pseudotumor Cerebri / Q000139:chemically induced* / Q000175:diagnosis; D013129:Spinal Puncture; D013909:Thorax / Q000002:abnormalities; D014424:Turner Syndrome / Q000150:complications; D014792:Visual Acuity
D019382:Human Growth Hormone