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Mea A Weaver, David L Rogers, Mary Lou K McGroegor, Shawn C Aylward; Secondary Intracranial Hypertension in Pediatric Patients with Growth Hormone Deficiency. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2189. doi: https://doi.org/.
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Growth Hormone Deficiency (GHD) can be congenital or acquired in childhood, and may be an isolated deficiency or occur in association with deficiencies of other pituitary hormones. Impaired growth leading to short stature is the hallmark of childhood GHD. Intracranial hypertension (IH) accompanied by papilledema has been reported in some patients with GHD. We report our series of patients with secondary intracranial hypertension associated with growth hormone deficiency.
A retrospective chart review of all children referred to Ophthalmology with diagnosis of hypopituitarism, as well as either papilledema or IH at Nationwide Children’s Hospital from Jan 2007 to Sep 2017.
Eleven children were identified, two were excluded as they were deceased and data was not available. Nine children ultimately met inclusion criteria, 5 females and 4 males. All of the patients were diagnosed with IH and six children had papilledema (67%) at the time of their diagnosis.Five of the nine had been started on growth hormone replacement therapy (GHRT) prior to discovery of IH. Headache was the presenting symptom in all of these patients. Two children (40%) developed IH, papilledema, and worsening headaches, within 3 months of starting GHRT. Initial treatment was to discontinue GHRT which improved headache symptoms. Three of the five children required Acetazolamide. One child (20%) developed IH without papilledema after being started on GHRT. Two children (40%) developed IH without papilledema approximately five years after starting GHRT. Lumbar puncture opening pressures for these 5 patients averaged 36 cm of H2O, all greater than 28 except one patient whose opening pressure was 24 in the presence of papilledema.Of the four children not on GHRT referred for evaluation due to headache, 100% were diagnosed with IH and papilledema. One of these patients had sixth cranial palsy. Two of these children required Acetazolamide. All of these children were diagnosed based on Ophthalmologic findings.
Our series of 11 patients demonstrate that patients with a diagnosis of growth hormone deficiency, regardless of the therapy, should be followed by ophthalmology to monitor for signs of papilledema.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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