Cushing's disease and idiopathic intracranial hypertension: case report and review of underlying pathophysiological mechanisms.
BACKGROUND
Several studies have reported an association between idiopathic intracranial hypertension (IIH) and deficits of the hypothalamic-pituitary-adrenal (HPA) axis.


METHODS
A 33-yr-old woman with Cushing's disease underwent successful surgical resection of a pituitary adenoma and developed IIH 11 months later after inadvertent withdrawal of oral glucocorticoids.


METHODS
A review of the literature was conducted to identify previous studies pertaining to IIH in association with neuroendocrine disease, focusing on reports related to HPA axis dysfunction.


RESULTS
A number of patients developing IIH due to a relative deficiency in glucocorticoids, after surgical or medical management for Cushing's disease, withdrawal from glucocorticoid replacement, or as an initial presentation of Addison's disease, have been reported. Hypotheses regarding the underlying pathophysiology of IIH in this context and, in particular, the role of cortisol and its relationship to other neuroendocrine and inflammatory mediators that may regulate the homeostasis of cerebrospinal fluid production and absorption are reviewed.


CONCLUSIONS
In a subset of patients, dysfunction of the HPA axis appears to play a role in the development of IIH. Hormonal control of cerebrospinal fluid production and absorption may be regulated by inflammatory mediators and the enzyme 11ß-hydroxysteroid dehydrogenase type 1. Further study of neuroendocrine markers in the serum and cerebrospinal fluid may be an avenue for further research in IIH.
Zada
Gabriel
G
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. gzada@usc.edu
Tirosh
Amir
A
Kaiser
Ursula B
UB
Laws
Edward R
ER
Woodmansee
Whitney W
WW
D000236:Adenoma / Q000150:complications* / Q000601:surgery; D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000150:complications* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery; D011559:Pseudotumor Cerebri / Q000139:chemically induced / Q000150:complications*; D013375:Substance Withdrawal Syndrome
D005938:Glucocorticoids