Management of pediatric patients with pseudotumor cerebri

PURPOSE Recent reports of the dramatic antitumor effect of all-trans-retinoic acid (RA) in patients with acute promyelocytic leukemia (APL) have renewed interest in the oncologic indications for retinoids. Furthermore, a variety of pediatric tumors are responsive to RA in vitro, which provides additional rationale for a phase I evaluation of RA in children with cancer that is refractory to standard therapy. PATIENTS AND METHODS A phase I trial of RA administered orally twice daily for 28-day treatment courses was performed. Cohorts of at least three pediatric cancer patients were entered at successive RA dose levels (from 45 to 80 mg/m2/d) until dose-limiting toxicity (DLT) was consistently observed. RESULTS The maximum-tolerated dose (MTD) of RA was 60 mg/m2/d. Three of eight patients at the 80-mg/m2/d dose level developed reversible pseudotumor cerebri that necessitated discontinuation of the agent. Both patients with APL achieved complete remission (CR), whereas no patients with solid tumors had objective responses. Pharmacokinetic studies demonstrated a relatively short terminal half-life for RA (45 minutes), with diminution in plasma levels after chronic dosing. CONCLUSIONS The MTD and recommended phase II dose for RA in children is 60 mg/m2/d given twice daily. Reversible CNS toxicity related to RA-induced pseudotumor cerebri is dose-limiting. Two children with APL achieved a CR to RA, which supports the inclusion of pediatric patients in clinical trials that evaluate the use of RA for patients with APL.

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Treatment Response in Pediatric Patients With Pseudotumor Cerebri Syndrome

Journal of Neuro-Ophthalmology ◽

10.1097/wno.0000000000000516 ◽

2017 ◽

Vol 37 (4) ◽

pp. 393-397 ◽

Cited By ~ 6

Author(s):

Eliel Tovia ◽

Shimon Reif ◽

Asaf Oren ◽

Alexis Mitelpunkt ◽

Aviva Fattal-Valevski

Keyword(s):

Treatment Response ◽

Pediatric Patients ◽

Pseudotumor Cerebri ◽

Pseudotumor Cerebri Syndrome

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Pseudotumor cerebri in patient on leuprolide acetate for central precocious puberty

International Journal of Pediatric Endocrinology ◽

10.1186/s13633-020-00092-4 ◽

2020 ◽

Vol 2020 (1) ◽

Cited By ~ 1

Author(s):

Anjumanara Anver Omar ◽

Godfrey Nyaga ◽

Lucy N Wainaina Mungai

Keyword(s):

Precocious Puberty ◽

Pediatric Patients ◽

Standard Of Care ◽

Central Precocious Puberty ◽

Pseudotumor Cerebri ◽

Leuprolide Acetate ◽

Gnrh Analogue ◽

Fundus Examination ◽

Case Presentation ◽

Routes Of Administration

Abstract 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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Idiopathic intracranial hypertension (pseudotumor cerebri) in pediatric patients

Pediatric Neurology ◽

10.1016/0887-8994(89)90002-7 ◽

1989 ◽

Vol 5 (1) ◽

pp. 5-11 ◽

Cited By ~ 64

Author(s):

Robert S. Baker ◽

Robert J. Baumann ◽

J.Raymond Buncic

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Pediatric Patients ◽

Pseudotumor Cerebri

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Audiology Service Models in a Family Physician Practice Setting

Perspectives on Audiology ◽

10.1044/poa6.1.24 ◽

2010 ◽

Vol 6 (1) ◽

pp. 24-32 ◽

Cited By ~ 2

Author(s):

Sridhar Krishnamurti

Keyword(s):

Pediatric Patients ◽

Practice Patterns ◽

Healthcare Delivery ◽

Direct Consequence ◽

Direct Access ◽

Practice Setting ◽

Pediatric Populations ◽

Family Practice Physicians ◽

Primary Focus ◽

Balance Problems

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

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