Double adverse drug reaction: Recombinant human growth hormone and idiopathic intracranial hypertension - Acetazolamide and metabolic acidosis: A case report

Gianluca Tornese, Giorgio Tonini, Federica Patarino, Fulvio Parentin, Federico Marchetti

Research output: Contribution to journalArticle

Abstract

A 9-year-old girl, treated for growth hormone deficiency, developed bitemporal progressive headache, diplopia, acute comitant esotropia and visual loss 3 months after starting recombinant growth hormone. An increased intracranial pressure was revealed by examination of ocular fundus and lumbar puncture, and the absence of other causes, ruled out through a brain scan, led to the diagnosis of idiopathic intracranial hypertension. Recombinant growth hormone was discontinued and acetazolamide started up to 30 mg/kg/die without any clinical improvement but developing metabolic acidosis. The switch to intravenous dexamethasone (0.4 mg/kg/die) led to a dramatic clinical improvement after only 1 day, then confirmed by examination of ocular fundus and visual evoked potentials. Currently, there are no evidence-based guidelines for the management of intracranial hypertension, and even though acetazolamide is recognized as the first-line drug, its efficacy and safety have not been proven: some patients might not respond and others will present unacceptable side-effects. Therefore we suggest the use of corticosteroids in intracranial hypertension when acetazolamide is inefficient or intolerable.

Original languageEnglish
Article number6534
JournalCases Journal
Volume2
Issue number6
DOIs
Publication statusPublished - Jun 2009

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Pseudotumor Cerebri
Acetazolamide
Human Growth Hormone
Acidosis
Drug-Related Side Effects and Adverse Reactions
Growth Hormone
Intracranial Hypertension
Esotropia
Spinal Puncture
Diplopia
Visual Evoked Potentials
Intracranial Pressure
Dexamethasone
Headache
Adrenal Cortex Hormones
Guidelines
Safety
Brain
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

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Double adverse drug reaction : Recombinant human growth hormone and idiopathic intracranial hypertension - Acetazolamide and metabolic acidosis: A case report. / Tornese, Gianluca; Tonini, Giorgio; Patarino, Federica; Parentin, Fulvio; Marchetti, Federico.

In: Cases Journal, Vol. 2, No. 6, 6534, 06.2009.

Research output: Contribution to journalArticle

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