Loukianou Eleni, Tasiopoulou Anastasia, Demosthenous Constantinos, Brouzas Dimitrios
Department of Ophthalmology, Makarios Hospital, 2012 Nicosia, Cyprus.
1st University Eye Clinic, 11527 Athens, Greece.
Case Rep Ophthalmol Med. 2016;2016:4756894. doi: 10.1155/2016/4756894. Epub 2016 Feb 4.
Purpose. To report a rare case of pseudotumor cerebri (PTC) in a child two months after receiving treatment with recombinant human growth hormone (rhGH) and to emphasize the need of close collaboration between ophthalmologists and pediatric endocrinologists in monitoring children receiving rhGH. Methods. A 12-year-old boy with congenital hypothyroidism started treatment with rhGH on a dose of 1,5 mg/daily IM (4.5 IU daily). Eight weeks later, he was complaining of severe headache without any other accompanying symptoms. The child was further investigated with computed tomography scan and lumbar puncture. Results. Computed tomography scan showed normal ventricular size and lumbar puncture revealed an elevated opening pressure of 360 mm H2O. RhGH was discontinued and acetazolamide 250 mg per os twice daily was initiated. Eight weeks later, the papilledema was resolved. Conclusions. There appears to be a causal relationship between the initiation of treatment with rhGH and the development of PTC. All children receiving rhGH should have a complete ophthalmological examination if they report headache or visual disturbances shortly after the treatment. Discontinuation of rhGH and initiation of treatment with acetazolamide may be needed and regular follow-up examinations by an ophthalmologist should be recommended.
目的。报告一例儿童在接受重组人生长激素（rhGH）治疗两个月后发生的罕见的假性脑瘤（PTC）病例，并强调眼科医生和儿科内分泌医生在监测接受rhGH治疗的儿童时密切合作的必要性。方法。一名12岁先天性甲状腺功能减退男孩开始接受rhGH治疗，剂量为每日1.5毫克肌肉注射（每日4.5国际单位）。八周后，他主诉严重头痛，无任何其他伴随症状。对该儿童进行了计算机断层扫描和腰椎穿刺进一步检查。结果。计算机断层扫描显示脑室大小正常，腰椎穿刺显示初压升高至360毫米水柱。停用rhGH，并开始口服乙酰唑胺，每日两次，每次250毫克。八周后，视乳头水肿消退。结论。rhGH治疗的开始与PTC的发生之间似乎存在因果关系。所有接受rhGH治疗的儿童如果在治疗后不久报告头痛或视觉障碍，都应进行全面的眼科检查。可能需要停用rhGH并开始使用乙酰唑胺治疗，同时应建议眼科医生进行定期随访检查。
