Successful Treatment of Idiopathic Intracranial Hypertension (IIH) with Octreotide (P03.229)

Abstract

Objective: To document a case of successful treatment of Ideopathic Intracranial Hypertension(IIH) with octreotide. Background Growth hormone mediated hyper secretion of CSF is the most accepted mechanism for IIH. Data from 57,968 children in the Pfizer International Growth Study database showed that IIH was one of the major side effects (80%) of GH. Octreotide, a somatostatin analogue, inhibits pituitary growth hormone(GH)secretion, and antagonizes GH and insulin like growth factor (IGF) action by blocking GH receptors. Design/Methods: A 39 year-old, obese female presented with headaches, intermittent visual blurring, and floaters for two years. Her examination was unremarkable except for papilloedema on fundoscopic exam. Computerized perimetry revealed marked impairment in the bilateral nasal fields. Brain MRI was normal, MR venogram showed hypoplastic left transverse venous sinus. The cerebrospinal fluid pressure was 30 cm of water, with a pulsatile CSF column. After initial use of diuretics being ineffective, lumbar punctures were recommended, but patient was not compliant to it. Results: Treatment with subcutaneous octreotide resulted in significant improvement of headaches, and normalization of visual fields and papilloedema. She tolerated the treatment well, except for formation of gallstones, for which treatment was stopped at around 9 months. However she continues to have persistent normalization of the vision and normal computerized perimetry after one and half year in follow up. Conclusions: Somatostatin receptors (SSTR I-5) are found in the choroid plexus, arachnoid granulations, and retina, which mediate the antisecretory and antiproliferative effects of somatostatin, which could be responsible for decreasing the intracranial pressure in IIH. Panagopoulos et al. treated 26 IIH patients with Octreotide for 6-8 months. Majority showed improvement of headache, visual symptoms, papilloedema and significant reduction of CSF pressure, which was persistent in follow up for three years. Further studies are warranted for its potential use in the treatment of IIH. Disclosure: Dr. Vyas has nothing to disclose. Dr. Phadke has received personal compensation for activities with Teva Neurosciences, Berlex and Glaxo Smith Kline as a speaker.