Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies

Wagner, Jeffrey; Fleseriu, Cara M.; Ibrahim, Aly; Cetas, Justin S.

doi:10.1016/j.wneu.2016.09.008

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…All included studies were either case reports ( n = 34) or case series ( n = 9). Five articles [ 8 , 9 , 14 , 15 , 16 ] also included a literature review and four [ 8 , 10 , 11 , 17 ] included cohort studies in addition to the case report/series. Included articles were published from 1981 to 2021 inclusively.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…We identified 11 cases of neurological disorders, including idiopathic intracranial hypertension (IIH) ( n = 5) [ 15 , 16 , 41 , 42 , 43 ], multiple sclerosis ( n = 2) [ 44 , 45 ], lymphocytic hypophysitis ( n = 2) [ 46 , 47 ], acute disseminated encephalomyelitis ( n = 1) [ 48 ] and myasthenia gravis ( n = 1) [ 49 ]. IIH has been associated with both primary adrenal insufficiency and steroid withdrawal [ 15 ]. Glucocorticoids are not routinely used as first‐line treatment of IIH (due to the risk of rebound intracranial hypertension upon withdrawal); however, three of the five cases included in this review were successfully treated with higher doses of steroids [ 15 , 16 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…IIH has been associated with both primary adrenal insufficiency and steroid withdrawal [ 15 ]. Glucocorticoids are not routinely used as first‐line treatment of IIH (due to the risk of rebound intracranial hypertension upon withdrawal); however, three of the five cases included in this review were successfully treated with higher doses of steroids [ 15 , 16 , 41 ]. Given this association, IIH was considered a steroid‐responsive condition for the purpose of this review.…”

Section: Resultsmentioning

confidence: 99%

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Emergence of De Novo Conditions Following Remission of Cushing Syndrome: A Case Report and Scoping Review

Desgagnés,

Senior,

Vis

et al. 2024

Endocrino Diabet & Metabol

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ObjectiveOnset and exacerbation of autoimmune, inflammatory or steroid‐responsive conditions have been reported following the remission of Cushing syndrome, leading to challenges in distinguishing a new condition versus expected symptomatology following remission. We describe a case of a 42‐year‐old man presenting with new‐onset sarcoidosis diagnosed 12 months following the surgical cure of Cushing syndrome and synthesise existing literature reporting on de novo conditions presenting after Cushing syndrome remission.MethodsA scoping review was conducted in Medline, Epub, Ovid and PubMed. Case reports and case series detailing adult patients presenting with new‐onset conditions following Cushing syndrome remission were included.ResultsIn total, 1641 articles were screened, 138 full‐text studies were assessed for eligibility, and 43 studies were included, of which 84 cases (including our case) were identified. Most patients were female (85.7%), and the median reported age was 39.5 years old (IQR = 13). Thyroid diseases were the most commonly reported conditions (48.8%), followed by sarcoidosis (15.5%). Psoriasis, lymphocytic hypophysitis, idiopathic intracranial hypertension, multiple sclerosis, rheumatoid arthritis, lupus and seronegative arthritis were reported in more than one case. The median duration between Cushing remission and de novo condition diagnosis was 4.1 months (IQR = 3.75). Of those patients, 59.5% were receiving corticosteroid therapy at the time of onset.ConclusionOur scoping review identified several cases of de novo conditions emerging following the remission of Cushing syndrome. They occurred mostly in women and within the year following remission. Clinicians should remain aware that new symptoms, particularly in the first year following the treatment of Cushing syndrome, may be manifestations of a wide range of conditions aside from adrenal insufficiency or glucocorticoid withdrawal syndrome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Emergence of De Novo Conditions Following Remission of Cushing Syndrome: A Case Report and Scoping Review

Desgagnés,

Senior,

Vis

et al. 2024

Endocrino Diabet & Metabol

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“…Typical features of PTCS are, among other signs and symptoms, papilledema as well as pronounced headache. It has previously been described in several case reports as well as one retrospective analysis of patients following successful transsphenoidal surgical or medical treatment of adrenocorticotropic hormone (ACTH) secreting pituitary adenoma [1][2][3][4][5][6][7]. ▶Table 1s provides an overview of clinical characteristics of these patients developing PTCS after successful surgery for Cushing's disease (CD).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Signs and Symptoms of Pseudotumor Cerebri Syndrome Before and After Transsphenoidal Surgery for Cushing’s Disease – A Prospective Consecutive Case Series

Huckhagel

Flitsch

Rotermund

et al. 2020

Exp Clin Endocrinol Diabetes

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Introduction Pseudotumor cerebri syndrome (PTCS) has anecdotally been described after successful treatment of Cushing’s disease (CD), but the prevalence following transsphenoidal surgery has not been determined so far in a prospective study. Patients and Methods 41 consecutive adult CD patients were prospectively screened for signs and symptoms of PTCS, headache-related impairment, and ophthalmological features associated with intracranial pressure elevation before surgery and at follow-up (mean 4 months). Results Biochemical remission was achieved in 36 of 41 (87.8%) patients after surgery. The most frequent preoperative complaints were visual acuity impairment (19 cases; 46.3%), headache (13 cases; 31.7%), and ear noise (9 cases; 22.0%). A significant reduction of visual disturbances was seen at follow-up. Overall, CD patients presented with fairly low headache-related emotional and functional restrictions before and after surgery. One of 34 (2.9%) patients with sufficient ophthalmological follow-up showed new-onset papilledema combined with temporary worsening of visual acuity and scotoma. Conclusion Our results suggest a very low frequency of signs and symptoms of PTCS after surgical treatment for CD in adults. This estimate is in line with previous outcomes from retrospective pediatric CD series. Further large-scale studies are needed to determine the actual prevalence of this condition following biochemical remission of CD.

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Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies

Cited by 6 publications

References 26 publications

Emergence of De Novo Conditions Following Remission of Cushing Syndrome: A Case Report and Scoping Review

Emergence of De Novo Conditions Following Remission of Cushing Syndrome: A Case Report and Scoping Review

Prevalence of Signs and Symptoms of Pseudotumor Cerebri Syndrome Before and After Transsphenoidal Surgery for Cushing’s Disease – A Prospective Consecutive Case Series

Hydrocortisone withdrawal

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