Alternate Causes of Pseudotumor Cerebri FREE

CORNELIS VAN DOP, MD, PHD

Am J Dis Child. 1985;139(6):545. doi:10.1001/archpedi.1985.02140080015013.

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ABSTRACT

ABSTRACT | REFERENCES

Sir.—The recent article by Huseman and Torkelson¹ suggests that the association of pseudotumor cerebri with initiation of thyroxine replacement, which has been reported in patients with primary hypothyroidism,^2-6 also occurs in patients with hypothalamic (tertiary) hypothyroidism. Two additional points should be considered.

First, patients with panhypopituitarism who are treated with thyroxine alone may experience rapid declines in plasma cortisol concentrations due to increased metabolism of cortisol.⁷ Since decreases in plasma cortisol concentrations can precipitate development of pseudotumor cerebri,^8,9 one must consider this condition as an alternate cause for the pseudotumor cerebri in the first patient.

In addition, the potential contribution of vitamin A to this syndrome is not discussed. Carotenemia¹⁰ and an elevated carotene–vitamin A ratio, common in hypothyroid patients, rapidly return to normal following institution of thyroxine replacement therapy.¹¹ As children seem to be more susceptible to increased intracranial pressure with vitamin

REFERENCES

ABSTRACT | REFERENCES

Huseman CA, Torkelson RD: Pseudotumor cerebri following treatment of hypothalamic and primary hypothyroidism . AJDC 1984;;138:927-931.

Van Wyk JJ, Grumbach MM: Syndrome of precocious menstruation and galactorrhea in juvenile hypothyroidism: An example of hormonal overlap in pituitary feedback . J Pediatr 1960;; 57:416-435.

Prendes JL, McLean WT Jr: Pseudotumor cerebri during treatment for hypothyroidism . South Med J 1978;;71:977.

Van Dop C, Conte FA, Koch TK, et al: Pseudotumor cerebri associated with initiation of levothyroxine therapy for juvenile hypothyroidism . N Engl J Med 1983;;308:1076-1080.

McVie R: Pseudotumor cerebri and thyroid-replacement therapy . N Engl J Med 1983;;309: 731.

Hymes LC, Warshaw BL, Schwartz JF: Pseudotumor cerebri and thyroid-replacement therapy . N Engl J Med 1983;;309:732.

Hellman L, Bradlow HL, Zumoff B, et al: The influence of thyroid hormones on hydrocortisone production and metabolism . J Clin Endocrinol Metabol 1961;;21:1231-1247.

Neville BGR, Wilson J: Benign intracranial hypertension following corticosteroid withdrawal in childhood . Br Med J 1970;;3:554-556.

Walsh FB: Papilledema associated with increased intracranial pressure in Addison's inease . Arch Ophthalmol 1952;;47:86.

Escamilla RF: Carotenemia in myxedema explanation of the typical slightly icteric tint . J Clin Endocrinol Metabol 1942;;2:33-35.

Walton KW, Campbell DA, Tonks EL: The significance of alterations in serum lipids in thyroid dysfunction: I. The relation between serum lipoproteins, carotenoids and vitamin A in hypothyroidism and thyrotoxicosis . Clin Sci 1965;; 29:199-215.

Stimson WH: Vitamin A intoxication in adults . N Engl J Med 1961;;265:369-373.

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