Ostry zez zbieżny jako objaw idiopatycznego nadciśnienia śródczaszkowego u 6-letniego dziecka leczonego rekombinowanym ludzkim hormonem wzrostu

Abstract

PurposeRecombinant human growth hormone (rhGH) has been used for treatment of growth hormone deficient children over 30 years. The rhGH has been demonstrated to have a relatively wide safety margin, but therapy requires strict monitoring. Headaches, especially in the first few months of therapy, require close evaluation as idiopathic intracranial hypertension (IIH) is found infrequently. To present acute esotropia secondary to idiopathic intracranial hypertension (IIH) in the course of recombinant human growth hormone (rhGH) therapy.Material and MethodsA 6-year-old girl, treated for growth hormone deficiency, developed acute esotropia and headache 2 months after starting rhGH therapy. IIH with bilateral papilloedema was diagnosed. The rhGH was discontinued.ResultsPapilledema resolved with the discontinuation of rhGH, and treatment with acetazolamide. Visual acuity was unchanged. The patient’s strabismus resolved after 7 weeks. Two months later rhGH therapy was restarted at a lower dose and gradually increased. Treatment continued for nine years, without any side effects.ConclusionsAcute onset esotropia can be the first sign of a intracranial hypertension in a child receiving rhGH. Children treated with rhGH should have a complete ophthalmic evaluation and should be carefully monitored, if they report headache or visual disturbances.