title: Presumed Pseudotumor Cerebri Syndrome After Withdrawal of Inhaled Glucocorticoids.
abstract: Pseudotumor cerebri syndrome (PTCS) is characterized by increased intracranial pressure with normal brain parenchyma and cerebrospinal fluid constituents. PTCS after withdrawal of systemic corticosteroids also has been described in children. In contrast, to our knowledge, PTCS after withdrawal of inhaled glucocorticoids has not previously been described. Here we report the case of an 8-year and 6-month-old girl who developed signs and symptoms consistent with PTCS after withdrawal of inhaled glucocorticoids. The patient had excellent adherence to inhaled glucocorticoid therapy for ∼1 year before presentation, after which the therapy was stopped for concern related to poor growth. The withdrawal of inhaled glucocorticoids was associated with the development of severe headaches and diplopia, and further clinical examination led to the patient's diagnosis of likely PTCS. Although its occurrence is likely rare, clinicians caring for the many children receiving inhaled glucocorticoid therapy should be aware of the potential for PTCS after abrupt withdrawal of such treatment, and consider ophthalmology evaluation if patients report suggestive symptoms, such as headaches or vision changes in this context.
authors.affiliation: Divisions of Human Genetics.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Kwon
authors.affiliation: Pulmonary Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Allen
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Ophthalmology, Neuro-ophthalmology Service, and.
authors.forename: Grant T
authors.initials: GT
authors.lastname: Liu
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and mccormacks1@email.chop.edu.
authors.forename: Shana E
authors.initials: SE
authors.lastname: McCormack
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004172:Diplopia / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006128:Growth / Q000187:drug effects; D006261:Headache / Q000209:etiology; D006801:Humans; D011559:Pseudotumor Cerebri / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D028761:Withholding Treatment
chemical_list: D005938:Glucocorticoids; D000086:Acetazolamide