Article: Pseudotumor cerebri in patient on leuprolide acetate for central precocious puberty

Background: Gonadotropin releasing hormone agonists (GnRHa) are well established as a standard of care for the treatment of central precocious puberty (CPP) worldwide. While numerous delivery systems and routes of administration exist, depot intramuscular injections or sustained-release preparations have been most widely used. Leuprolide acetate is well tolerated among children though some can develop some complications.

Case Presentation: We present a case report of a 6.5 year old girl with central precocious puberty who developed signs of pseudotumor cerebri after 2 doses of leuprolide acetate 3.75 mg given monthly. Systemic exam and other tests to look for the cause did not yield anything. However, fundoscopy showed marked papilloedema with blurred disc margins. After six weeks' treatment with acetazolamide and withdrawal of the GRNHa the papilloedema resolved.

Conclusions: If a patient presents with complaints such as headache, nausea, vomiting, and double vision in pediatric patients treated with GnRH analogue one should highly consider the presence of pseudotumor cerebri and fundus examination be performed.

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References

1.

Babikian P, Corbett J, Bell W . Idiopathic intracranial hypertension in children: the Iowa experience. J Child Neurol. 1994; 9(2):144-9. DOI: 10.1177/088307389400900208. View

2.

Mul D, Hughes I . The use of GnRH agonists in precocious puberty. Eur J Endocrinol. 2008; 159 Suppl 1:S3-8. DOI: 10.1530/EJE-08-0814. View

3.

Bangalore Krishna K, Fuqua J, Rogol A, Klein K, Popovic J, Houk C . Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res Paediatr. 2019; 91(6):357-372. DOI: 10.1159/000501336. View

4.

Conteduca V, Di Lorenzo G, Tartarone A, Aieta M . The cardiovascular risk of gonadotropin releasing hormone agonists in men with prostate cancer: an unresolved controversy. Crit Rev Oncol Hematol. 2012; 86(1):42-51. DOI: 10.1016/j.critrevonc.2012.09.008. View

5.

Chen M, Eugster E . Central Precocious Puberty: Update on Diagnosis and Treatment. Paediatr Drugs. 2015; 17(4):273-81. PMC: 5870137. DOI: 10.1007/s40272-015-0130-8. View

6.

Phillips P, Repka M, Lambert S . Pseudotumor cerebri in children. J AAPOS. 1999; 2(1):33-8. DOI: 10.1016/s1091-8531(98)90107-0. View

7.

Galgano M, Deshaies E . An update on the management of pseudotumor cerebri. Clin Neurol Neurosurg. 2012; 115(3):252-9. DOI: 10.1016/j.clineuro.2012.11.018. View

8.

Boot J . Pseudotumour cerebri as a side effect of leuprorelin acetate. Ir J Med Sci. 1996; 165(1):60. DOI: 10.1007/BF02942809. View

9.

Per H, Canpolat M, Gumus H, Poyrazoglu H, Yikilmaz A, Karakucuk S . Clinical spectrum of the pseudotumor cerebri in children: etiological, clinical features, treatment and prognosis. Brain Dev. 2012; 35(6):561-8. DOI: 10.1016/j.braindev.2012.08.008. View

10.

Ko M, Liu G . Pediatric idiopathic intracranial hypertension (pseudotumor cerebri). Horm Res Paediatr. 2010; 74(6):381-9. DOI: 10.1159/000321180. View

11.

Balbi G, Matas S, Len C, Fraga M, Sousa I, Terreri M . Pseudotumor cerebri in childhood and adolescence: data from a specialized service. Arq Neuropsiquiatr. 2018; 76(11):751-755. DOI: 10.1590/0004-282X20180131. View

12.

Gul U, Bayram A, Kendirci M, Hatipoglu N, Okdemir D, Gumus H . Pseudotumour Cerebri Presentation in a Child Under the Gonadotropin-Releasing Hormone Agonist Treatment. J Clin Res Pediatr Endocrinol. 2016; 8(3):365-7. PMC: 5096505. DOI: 10.4274/jcrpe.2212. View

Pseudotumor Cerebri in Patient on Leuprolide Acetate for Central Precocious Puberty