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Sheldon CA, Paley GL, Beres SJ, McCormack SE, Liu GT. Pediatric Pseudotumor Cerebri Syndrome: Diagnosis, Classification, and Underlying Pathophysiology. Semin Pediatr Neurol 2017; 24:110-115. [PMID: 28941525 PMCID: PMC7786295 DOI: 10.1016/j.spen.2017.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pseudotumor cerebri syndrome (PTCS) is defined by the presence of elevated intracranial pressure in the setting of normal brain parenchyma and cerebrospinal fluid. PTCS can occur in the pediatric and adult populations and, if untreated, may lead to permanent visual loss. In this review, discussion will focus on PTCS in the pediatric population and will outline its distinct epidemiology and key elements of diagnosis, evaluation and management. Finally, although the precise mechanisms are unclear, the underlying pathophysiology will be considered.
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Affiliation(s)
- Claire A Sheldon
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Grace L Paley
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Shana E McCormack
- Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA
| | - Grant T Liu
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Neurology, Division of Neuro-Ophthalmology, Hospital of the University of Philadelphia, PA
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An integrated mechanism of pediatric pseudotumor cerebri syndrome: evidence of bioenergetic and hormonal regulation of cerebrospinal fluid dynamics. Pediatr Res 2015; 77:282-9. [PMID: 25420176 PMCID: PMC4641240 DOI: 10.1038/pr.2014.188] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/20/2014] [Indexed: 12/15/2022]
Abstract
Pseudotumor cerebri syndrome (PTCS) is defined by the presence of elevated intracranial pressure (ICP) in the setting of normal brain parenchyma and cerebrospinal fluid (CSF). Headache, vision changes, and papilledema are common presenting features. Up to 10% of appropriately treated patients may experience permanent visual loss. The mechanism(s) underlying PTCS is unknown. PTCS occurs in association with a variety of conditions, including kidney disease, obesity, and adrenal insufficiency, suggesting endocrine and/or metabolic derangements may occur. Recent studies suggest that fluid and electrolyte balance in renal epithelia is regulated by a complex interaction of metabolic and hormonal factors; these cells share many of the same features as the choroid plexus cells in the central nervous system (CNS) responsible for regulation of CSF dynamics. Thus, we posit that similar factors may influence CSF dynamics in both types of fluid-sensitive tissues. Specifically, we hypothesize that, in patients with PTCS, mitochondrial metabolites (glutamate, succinate) and steroid hormones (cortisol, aldosterone) regulate CSF production and/or absorption. In this integrated mechanism review, we consider the clinical and molecular evidence for each metabolite and hormone in turn. We illustrate how related intracellular signaling cascades may converge in the choroid plexus, drawing on evidence from functionally similar tissues.
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Salpietro V, Polizzi A, Di Rosa G, Romeo AC, Dipasquale V, Morabito P, Chirico V, Arrigo T, Ruggieri M. Adrenal disorders and the paediatric brain: pathophysiological considerations and clinical implications. Int J Endocrinol 2014; 2014:282489. [PMID: 25276129 PMCID: PMC4167812 DOI: 10.1155/2014/282489] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/12/2014] [Indexed: 01/27/2023] Open
Abstract
Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency) has been reported with neurological and magnetic resonance imaging (MRI) abnormalities (e.g., delayed myelination and brain atrophy) due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH), a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF) pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS) through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric) CNS seems to be particularly vulnerable to alterations induced by adrenal disorders and/or supraphysiological doses of corticosteroids. Physicians should be aware of potential neurological manifestations in children with adrenal dysfunction to achieve better prevention and timely diagnosis and treatment of these disorders. Further studies are needed to explore the potential neurological, cognitive, and psychiatric long-term consequences of high doses of prolonged corticosteroid administration in childhood.
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Affiliation(s)
- Vincenzo Salpietro
- Department of Pediatric Neurology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Agata Polizzi
- National Center for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
- Institute of Neurological Sciences, National Research Council, Catania, Italy
| | - Gabriella Di Rosa
- Infantile Neuropsychiatry Unit, Department of Pediatrics, University of Messina, Italy
| | - Anna Claudia Romeo
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Valeria Dipasquale
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Paolo Morabito
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy
| | - Valeria Chirico
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Teresa Arrigo
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Martino Ruggieri
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Italy
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Nygren A, Sunnegårdh J, Teien D, Jonzon A, Björkhem G, Lindell S, Albertsson-Wikland K, Kriström B. Rapid cardiovascular effects of growth hormone treatment in short prepubertal children: impact of treatment duration. Clin Endocrinol (Oxf) 2012; 77:877-84. [PMID: 22651572 DOI: 10.1111/j.1365-2265.2012.04456.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous studies show that growth hormone (GH) treatment increases cardiac dimensions in short children with GH deficiency (GHD) and has diverse cardiac effects in children with idiopathic short stature (ISS). This study was performed to assess the effect of GH on the cardiovascular system in short children with a broad range of GH secretion and GH sensitivity/responsiveness. DESIGN AND PATIENTS In this prospective, multicentre study, short prepubertal children diagnosed with isolated GHD (89) or ISS (38) were followed during 2 years of GH treatment. They were randomized to receive either a standard (43 μg/kg/day) or an individualized GH dose (range 17-100 μg/kg/day) based on GH responsiveness estimated by a prediction model and distance to target height. Echocardiography, blood pressure and electrocardiography were performed at baseline, 3, 12 and 24 months. RESULTS Left ventricular mass (LVM) indexed to body surface area increased significantly during 2 years of GH treatment in both GHD and ISS irrespective of randomized dose. This change was already apparent at 3 months, when standard deviation scores (SDS) of wall thickness and diameter were increased. At 24 months, left ventricular diameter SDS remained increased, whereas myocardial thickness SDS returned to baseline values. There was no impairment of systolic or diastolic function. There was no correlation with treatment dose and LVM SDS at 24 months. CONCLUSIONS Irrespective of GH status, there was a rapid increase in LVM during GH treatment in short children. At 3 months, wall thickness and diameter were increased, whereas only diameter remained increased at 24 months.
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Affiliation(s)
- Anders Nygren
- Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Boonsanit D, Chanpongsang S, Chaiyabutr N. Effects of supplemental recombinant bovine somatotropin and mist-fan cooling on the renal tubular handling of sodium in different stages of lactation in crossbred Holstein cattle. Res Vet Sci 2011; 93:417-26. [PMID: 21862090 DOI: 10.1016/j.rvsc.2011.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 05/30/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022]
Abstract
The effect of supplementary administration of recombinant bovine somatotrophin (rbST) on the renal tubular handling of sodium in crossbred 87.5% Holstein cattle housed in normal shade (NS) or mist-fan cooled (MF) barns was evaluated. The cows were injected with 500 mg rbST at three different stages of lactation. The MF barn housed cows showed a slightly decreased ambient temperature and temperature humidity index, but an increased relative humidity. Rectal temperature and respiration rates were significantly lower in cooled cows. The rbST treated cows, housed in NS or MF barns, showed markedly increased milk yields, total body water, extracellular fluid and plasma volume levels, along with a reduced rate of urine flow and urinary excretion of sodium, potassium and chloride ions and osmolar clearance, in all three stages of lactation. Renal tubular sodium and water reabsorption were increased after rbST administration without any alteration in the renal hemodynamics. Lithium clearance data suggested that the site of response is in the proximal nephron segment, which may be mediated via increases in the plasma levels of aldosterone and IGF-1, but not vasopressin, during rbST administration.
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Affiliation(s)
- Dolrudee Boonsanit
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant, Bangkok 10330, Thailand
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Bielohuby M, Roemmler J, Manolopoulou J, Johnsen I, Sawitzky M, Schopohl J, Reincke M, Wolf E, Hoeflich A, Bidlingmaier M. Chronic growth hormone excess is associated with increased aldosterone: a study in patients with acromegaly and in growth hormone transgenic mice. Exp Biol Med (Maywood) 2009; 234:1002-9. [PMID: 19491373 DOI: 10.3181/0901-rm-34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acromegaly is a disease characterized by chronic growth hormone (GH) excess. Since hypertension is a common finding in patients with acromegaly, interactions between GH and the renin-angiotensin-aldosterone system (RAAS) are under controversial debate. We examined GH, IGF-I, aldosterone, and renin in a well-defined group of acromegalic patients before and after cure by surgery. In addition, we analyzed the impact of chronic GH excess on the RAAS in mouse models over-expressing GH alone (G) or in combination with insulin-like growth factor-binding protein-2 (IGFBP-2; GB). Normalization of GH secretion after cure by surgery was accompanied by significant decreases of serum aldosterone in acromegalic patients (pre-op: 96.5 +/- 37.1 pg/mL, post-op: 41.3 +/- 28.2 pg/ mL; P < 0.001; n = 13), but renin concentrations were unaffected. In addition, aldosterone concentrations were positively correlated to GH levels (Spearman r = 0.39; P = 0.025; n = 26). To further study this association, we analysed two transgenic mouse models and found a similar relationship between GH and aldosterone in G mice, which showed about 3-fold elevated serum aldosterone levels in comparison to non-transgenic controls (males: 442 +/- 331 pg/mL vs. 151 +/- 84 pg/mL; P = 0.002; n > or = 12; females: 488 +/- 161 pg/mL vs. 108 +/- 125 pg/mL; P = 0.05; n > or = 4). Expression of aldosterone synthase was similar in adrenal glands of C and G mice. Aldosterone levels in G and GB mice of both genders were not different, indicating that the elevated aldosterone was due to GH excess and not caused by elevated IGF-I, which is known to be blocked by IGFBP-2 overexpression. Also in the mouse models, changes in aldosterone were independent from renin. In summary, we show that chronic GH excess is associated with increased aldosterone in humans and mice. GH-induced increases of aldosterone potentially contribute to the increased cardiovascular risk in acromegalic patients. The underlying mechanism is likely to be independent of renin, excess IGF-I, or adrenal aldosterone synthase expression.
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Affiliation(s)
- Maximilian Bielohuby
- Medizinische Klinik - Innenstadt Klinikum der Universität, Ziemssenstr. 1, 80336 Munich, Germany
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Shen W, St-Onge MP, Pietrobelli A, Wang J, Wang Z, Heshka S, Heymsfield SB. Four-compartment cellular level body composition model: comparison of two approaches. ACTA ACUST UNITED AC 2005; 13:58-65. [PMID: 15761163 PMCID: PMC1993905 DOI: 10.1038/oby.2005.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to develop and compare two DXA-based four-compartment [body weight=body cell mass (BCM)+extracellular fluid (ECF)+extracellular solids (ECS)+fat] cellular level models. RESEARCH METHODS AND PROCEDURES Total body potassium (TBK) model: BCM from TBK by whole-body counting-ECF(TBK)=LST-[BCM(TBK)+0.73 x osseous mineral (Mo)]. Bromide model: ECF from sodium bromide dilution-BCM(BROMIDE)=LST-(ECF(BROMIDE)+0.73xMo); Mo and LST measurements came from DXA. The two approaches were evaluated in 99 healthy men and 118 women. RESULTS BCM estimates were highly correlated (r=0.97, p<0.001), as were ECF estimates (r=0.87, p<0.001); a small statistically significant mean difference was present (mean+/-SD; BCM(TBK) model, 30.4+/-8.9 kg; BCM(BROMIDE), 31.4+/-9.3 kg; Delta=1.0+/-2.8 kg; p<0.001; ECF(TBK), 18.5+/-4.2 kg; ECF(BROMIDE), 17.5+/-3.6 kg; Delta=1.0+/-2.8 kg; p<0.001). A high correlation (r=0.97, p<0.001) and good agreement (38.9+/-9.5 vs. 38.9+/-9.5 kg; Delta=0.0+/-2.4 kg; p=0.39) were present between TBW, derived as the sum of intracellular water from TBK and ECW from bromide, and measured TBW by 2H2O dilution. DISCUSSION Two developed four-compartment cellular level DXA models, one of which is appropriate for use in most clinical and research settings, provide comparable results and are applicable for BCM and ECF estimation of subject groups with hydration disturbances.
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Affiliation(s)
- Wei Shen
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
| | - Marie-Pierre St-Onge
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
| | | | - Jack Wang
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
| | - ZiMian Wang
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
| | - Stanley Heshka
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
| | - Steven B. Heymsfield
- Obesity Research Center, St. Luke’s-Roosevelt Hospital, Columbia University College of Physicians and Surgeons and Institute of Human Nutrition, New York, New York
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Affiliation(s)
- Jens Møller
- Medical Department, Aarhus Kommunehospital, Institute of Clinical Experimental Research, University of Aarhus, DK-8000 Aarhus C., Denmark.
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Clayton PE, Cowell CT. Safety issues in children and adolescents during growth hormone therapy--a review. Growth Horm IGF Res 2000; 10:306-317. [PMID: 11161961 DOI: 10.1054/ghir.2000.0175] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The action of growth hormone (GH) via its receptor involves many organ systems and metabolic pathways. These diverse actions are reviewed in this paper in the context that they may represent unwanted side-effects of GH therapy for growth promotion. The monitoring of GH therapy in large multicentre international databases has demonstrated a low frequency of adverse events. Tumour recurrence or new malignancy are not increased. Headaches, especially in the first few months of therapy, require close evaluation as benign intracranial hypertension is found infrequently, especially in children with GH deficiency and chronic renal failure (CRF). Children at risk for slipped capital femoral epiphysis and scoliosis require close monitoring during therapy. Decreased insulin sensitivity that is dose-dependent is observed during GH therapy. Glucose homeostasis, however, is not affected, but a recent report of increased incidence of Type 2 diabetes mellitus in children undergoing GH therapy requires prospective surveillance.
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Affiliation(s)
- P E Clayton
- Department of Child Health, Royal Manchester Children's Hospital, Manchester, UK
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BROOK C, KELNAR C, BETTS P. Which children should receive growth hormone treatment. Cost-benefit analysis is the key. Arch Dis Child 2000. [PMID: 10950748 PMCID: PMC1718444 DOI: 10.1136/adc.83.2.176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C BROOK
- University College London The Middlesex Hospital, Mortimer Street London W1N 8AA, UK.
| | - C. KELNAR
- University College London The Middlesex Hospital, Mortimer Street London W1N 8AA, UK.
| | - P. BETTS
- University College London The Middlesex Hospital, Mortimer Street London W1N 8AA, UK.
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