scholarly journals Intracranial hypertension and empty Sella from adrenal adenoma and excessive and prolonged steroid usage: a case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Naiqian Zhao ◽  
Weixia Yang ◽  
Xiaoyan Li ◽  
Li Wang ◽  
Ying Feng
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Low Dose ◽  
Adrenal Adenoma ◽  
Empty Sella ◽  
Elevated Intracranial Pressure ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Free Cortisol

Abstract Background There is only one documented case of intracranial hypertension (IH) and empty sella from cortisol-producing adrenal adenoma so far. And IH and empty sella caused by long-term exogenous hypercortisolism has never been reported before. The purpose of this case report is to alert clinicians to glucocorticoid-induced IH. Case presentation We present retrospectively a 50-year-old woman with cortisol-secreting adrenal adenoma, who progressed to intractable intracranial hypertension and a markedly expanded empty sella due to improper treatment. In 2011, the patient presented with hypertension, lack of cortisol circadian rhythm, low ACTH, a left adrenal adenoma and a partial empty sella, but did not receive low-dose dexamethasone suppression test (LDDST) and 24-h urinary cortisol. In 2014, she exhibited truncal obesity, raised cortisol, LDDST non-suppression, high urinary free cortisol and low ACTH, proving her cortisol-producing adrenal adenoma. She was simultaneously diagnosed with unexplained IH because of papilledema and elevated intracranial pressure, and her partial empty sella changed to a complete empty sella. In 2015, she underwent adrenal adenoma resection. From 2015 to 2018, she kept taking dexamethasone at least 2 mg daily without her doctors’ consent. During this period, she developed transient cerebrospinal fluid rhinorrhea, and her empty sella further worsened. After switching to low dose hydrocortisone, her papilledema disappeared completely, but optic atrophy has become irreversible. Conclusions The patient seems to be just an extreme case, but it may reveal and illustrate a general phenomenon: Both cortisol-producing adrenal adenoma and long-term exogenous hypercortisolism could cause varying degrees of elevated intracranial pressure and empty sella. Clinicians should remain vigilant for this phenomenon in patients with cortisol-producing adrenal adenoma or excessive and prolonged steroid usage and give them corresponding examinations to identify this complication.

scholarly journals Idiopathic intracranial hypertension presenting as iron deficiency anemia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Peng Yong Sim ◽  
Priyal Taribagil ◽  
Ione O. C. Woollacott ◽  
Safina Rashid ◽  
Desmond P. Kidd
Keyword(s):  
Case Report ◽  
Iron Deficiency ◽  
Intracranial Hypertension ◽  
Iron Deficiency Anemia ◽  
Idiopathic Intracranial Hypertension ◽  
Deficiency Anemia ◽  
Visual Deficits ◽  
Fluid Analysis ◽  
Optic Disc Swelling

Abstract Background The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare. Case presentation This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits. Conclusion The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.

scholarly journals Osteomalacia and renal failure due to Fanconi syndrome caused by long-term low-dose Adefovir Dipivoxil: a case report

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Xiang ◽  
Zhiyan Liu ◽  
Yanyan Yu ◽  
Hanxu Zhang ◽  
Qiufen Xie ◽  
...  
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Adefovir Dipivoxil ◽  
Fanconi Syndrome ◽  
Low Dose

Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

2008 ◽  
Vol 2 (4) ◽  
pp. 240-249 ◽  
Author(s):  
Jay Jagannathan ◽  
David O. Okonkwo ◽  
Hian Kwang Yeoh ◽  
Aaron S. Dumont ◽  
Dwight Saulle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Pediatric Patients ◽  
Elevated Intracranial Pressure ◽  
The Mean

Object The management strategies and outcomes in pediatric patients with elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study. Methods This study was a retrospective review of a prospectively acquired pediatric trauma database. More than 750 pediatric patients with brain injury were seen over a 10-year period. Records were retrospectively reviewed to determine interventions for correcting ICP, and surviving patients were contacted prospectively to determine functional status and quality of life. Only patients with 2 years of follow-up were included in the study. Results Ninety-six pediatric patients (age range 3–18 years) were identified with a Glasgow Coma Scale score < 8 and elevated ICP > 20 mm Hg on presentation. The mean injury severity score was 65 (range 30–100). All patients were treated using a standardized head injury protocol. The mean time course until peak ICP was 69 hours postinjury (range 2–196 hours). Intracranial pressure control was achieved in 82 patients (85%). Methods employed to achieve ICP control included maximal medical therapy (sedation, hyperosmolar therapy, and paralysis) in 34 patients (35%), ventriculostomy in 23 patients (24%), and surgery in 39 patients (41%). Fourteen patients (15%) had refractory ICP despite all interventions, and all of these patients died. Seventy-two patients (75%) were discharged from the hospital, whereas 24 (25%) died during hospitalization. Univariate and multivariate analysis revealed that the presence of vascular injury, refractory ICP, and cisternal effacement at presentation had the highest correlation with subsequent death (p < 0.05). Mean follow-up was 53 months (range 11–126 months). Three patients died during the follow-up period (2 due to infections and 1 committed suicide). The mean 2-year Glasgow Outcome Scale score was 4 (median 4, range 1–5). The mean patient competency rating at follow-up was 4.13 out of 5 (median 4.5, range 1–4.8). Univariate analysis revealed that the extent of intracranial and systemic injuries had the highest correlation with long-term quality of life (p < 0.05). Conclusions Controlling elevated ICP is an important factor in patient survival following severe pediatric TBI. The modality used for ICP control appears to be less important. Long-term follow-up is essential to determine neurocognitive sequelae associated with TBI.

scholarly journals Long term control of a maxillary sinus mucoepidermoid carcinoma with low dose radiation therapy: a case report

2013 ◽  
Vol 8 (1) ◽  
Author(s):  
Horia Vulpe ◽  
Meredith Giuliani ◽  
David Goldstein ◽  
Bayardo Perez-Ordonez ◽  
Laura A Dawson ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Case Report ◽  
Maxillary Sinus ◽  
Mucoepidermoid Carcinoma ◽  
Low Dose ◽  
Low Dose Radiation ◽  
Dose Radiation

scholarly journals Idiopathic Intracranial Hypertension Developing After Levothyroxine Replacement in a Patient with Acquired Primary Hypothyroidism- A Case Report

2011 ◽  
Vol 29 (1) ◽  
pp. 49-51 ◽  
Author(s):  
MA Haque ◽  
LS Sharmin ◽  
QT Islam
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Iron Deficiency ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Primary Hypothyroidism ◽  
Steroid Withdrawal ◽  
Cushing Disease ◽  
Levothyroxine Replacement ◽  
Intracranial Lesions

Idiopathic intracranial hypertension (IIH) is the persistent increase in intracranial pressure in the absence of any intracranial lesions. Though termed idiopathic IIH is known to be associated with a wide variety of disease conditions and drugs i.e. SLE, adrenal insufficiency, Cushing disease, hypoparathyroidism, hypothyroidism, iron deficiency, vitamin A, tetracycline, nalidixic acid, steroid withdrawal and many others. IIH is a rare disease, but IIH developing after replacement of levothyroxine is even rarer. Only a handful of cases of IIH associated with levothyroxine therapy have been mentioned in the literature. We are reporting a case of IIH developing after starting levothyroxine replacement and then the literature is reviewed. DOI: 10.3329/jbsp.v29i1.7173J Bangladesh Coll Phys Surg 2011; 29:49-51

scholarly journals Possible Spironolactone Induced Intracranial Hypertension in a Patient with Androgenetic Alopecia: A Case Report

2018 ◽  
Vol 12 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Hamad Albraidi ◽  
Omar Alzuman ◽  
Abdulmajeed Alajlan
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Adverse Events ◽  
Intracranial Hypertension ◽  
Androgenetic Alopecia ◽  
Androgen Level

Spironolactone is a well-known drug with many indications. In dermatology, it may be used for treating androgenetic alopecia with a high androgen level. A patient with idiopathic papilledema that was inactive for many years experienced a significant increase in intracranial pressure after receiving spironolactone. The symptoms were resolved soon after the medication was discontinued. This report draws physicians’ attention to such rare adverse events that may have unwanted consequences.

Elimination of methohexitone after long-term, high-dose infusion in patients with critically elevated intracranial pressure

1999 ◽  
Vol 27 (8) ◽  
pp. 1570-1576 ◽  
Author(s):  
Joachim Schickendantz ◽  
Wolfgang Funk ◽  
Karl-Peter Ittner ◽  
Michael Gruber ◽  
Kai Taeger ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
High Dose ◽  
Elevated Intracranial Pressure ◽  
Dose Infusion

Asymptomatic Versus Symptomatic Idiopathic Intracranial Hypertension in Children

2019 ◽  
Vol 34 (12) ◽  
pp. 751-756 ◽  
Author(s):  
Keerthi T. Gondi ◽  
Kevin S. Chen ◽  
Sean M. Gratton
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Age Of Onset ◽  
Elevated Intracranial Pressure ◽  
Retrospective Case ◽  
Symptomatic Disease ◽  
Fluid Analysis ◽  
Hypertension Diagnosis ◽  
Magnetic Resonance Imaging Mri

Background: Idiopathic intracranial hypertension is a rare neurologic condition characterized by elevated intracranial pressure with normal cerebrospinal fluid analysis and neuroimaging. A subset of pediatric idiopathic intracranial hypertension patients are coincidentally found to have papilledema and elevated intracranial pressure without symptoms (eg, headache, visual blurring, tinnitus). This study aims to investigate the features of asymptomatic pediatric idiopathic intracranial hypertension. Methods: Retrospective case-control study of patients aged 0 to 18 years who received idiopathic intracranial hypertension diagnosis from 2005 to 2016. Subjects were included if they met established diagnostic criteria for idiopathic intracranial hypertension diagnosis. Subjects were classified as symptomatic if they presented with 1 symptom related to elevated intracranial pressure, and asymptomatic if no symptoms were present. Statistical analysis was performed to compare the 2 groups. Results: 12 (22.6%) of 53 pediatric idiopathic intracranial hypertension subjects were asymptomatic. Compared to symptomatic idiopathic intracranial hypertension, asymptomatic idiopathic intracranial hypertension had younger age of onset, lower initial opening pressure on lumbar puncture, lower optic nerve edema grades bilaterally, lower likelihood of globe flattening on magnetic resonance imaging (MRI), and smaller required dose of acetazolamide for resolution of papilledema (all P < .05). Conclusion: Asymptomatic idiopathic intracranial hypertension is common among pediatric patients with papilledema and is an important disease entity that requires special clinical management. It may exist as a milder version of idiopathic intracranial hypertension that occurs in younger children, or as a precursor state that later evolves into symptomatic disease.

Sign in / Sign up

Export Citation Format

Share Document