Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
-
Derya Tepe
, Fatma Demirel
, Esra Dag Seker , Ebru Petek Arhan , Meltem Tayfun , Ihsan Esen , Ozlem Kara and Murat Kizilgun
Abstract
Background:
Idiopathic intracranial hypertension (IIH) is one of the most important and rare complications of obesity. Prevalence of IIH in childhood obesity is not known. The purpose of this study was to determine the prevalence of IIH in obese children and adolescents and to investigate the relevant factors.
Methods:
In this study, 1058 obese children and adolescents between 2 and 18 years of age were included. Funduscopic examination was conducted for all subjects. In cases with papilledema, increase in intracranial pressure was clarified by measuring CSF pressure with a lumbar puncture. Other causes of IIH were ruled out with clinical, laboratory tests and imaging techniques.
Results:
Idiopathic intracranial hypertension was diagnosed in 14 subjects (1.32%). Rates of headache and systemic hypertension in subjects with IIH was determined to be 78.6% and 28.6%, respectively. Morning cortisol, fasting insulin and HOMA-IR values were found to be significantly higher in this cases (p<0.05).
Conclusions:
In childhood obesity, IIH should be kept in mind as a serious complication. Funduscopic examination is an easy method that suggests IIH. In particular, obese children with systemic hypertension and refractory headache should be considered for IIH.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492–5.10.1212/01.WNL.0000029570.69134.1BSearch in Google Scholar PubMed
2. Rangwala LM, Liu GT. Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 2007;52:597–17.10.1016/j.survophthal.2007.08.018Search in Google Scholar PubMed
3. Ko MW, Liu GT. Pediatric idiopathic intracranial hypertension (pseudotumor cerebri). Horm Res Paediatr 2010;74:381–9.10.1159/000321180Search in Google Scholar PubMed
4. Babikian P, Corbett J, Bell W. Idiopathic intracranial hypertension in children: the Iowa experience. J Child Neurol 1994;9:144–9.10.1177/088307389400900208Search in Google Scholar PubMed
5. Salpietro V, Mankad K, Kinali M, Adams A, Valenzise M, et al. Pediatric idiopathic intracranial hypertension and the underlying endocrine-metabolic dysfunction: a pilot study. J Pediatr Endocrinol Metab 2014;27:107–15.10.1515/jpem-2013-0156Search in Google Scholar PubMed
6. Noto R, Maneatis T, Frane J, Alexander K, Lippe B, et al. Intracranial hypertension in pediatric patients treated with recombinant human growth hormone: data from 25 years of the Genentech National Cooperative Growth Study. J Pediatr Endocrinol Metab 2011;24:627–31.10.1515/JPEM.2011.319Search in Google Scholar PubMed
7. Bala P, McKiernan J, Gardiner C, O’Connor G, Murray A. Turner’s syndrome and benign intracranial hypertension with or without growth hormone treatment. J Pediatr Endocrinol Metab 2004;17:1243–4.10.1515/JPEM.2004.17.9.1243Search in Google Scholar
8. Obeid M, Price J, Sun L, Scantlebury MH, Overby P, et al. Facial palsy and idiopathic intracranial hypertension in twins with cystic fibrosis and hypovitaminosis A. Pediatr Neurol 2011;44:150–2.10.1016/j.pediatrneurol.2010.10.002Search in Google Scholar PubMed
9. Lewis CD, Traboulsi EI, Rothner AD, Jeng BH. Xerophthalmia and intracranial hypertension in an autistic child with vitamin A deficiency. J Pediatr Ophthalmo Strabismus 2010;26:1–3.10.3928/01913913-20100318-04Search in Google Scholar PubMed
10. Keating JP, Feigin RD. Increased intracranial pressure associated with probable vitamin A deficiency in cystic fibrosis. Pediatrics 1970;46:41–6.10.1542/peds.46.1.41Search in Google Scholar
11. Dotan G, Goldstein M, Stolovitch C, Kesler A. Pediatric pseudotumor cerebri associated with low serum levels of vitamin A. J Child Neurol 2013;28:1370–7.10.1177/0883073812474344Search in Google Scholar PubMed
12. Zaki SA, Lad V, Abdagire N. Vitamin D deficiency rickets presenting as pseudotumor cerebri. J Neurosci Rural Pract 2013;4:464–6.10.4103/0976-3147.120210Search in Google Scholar PubMed PubMed Central
13. DeJong AR, Callahan CA, Weiss J. Pseudotumorcerebri and nutritional rickets. Eur J Pediatr 1985;143:219–20.10.1007/BF00442144Search in Google Scholar PubMed
14. Murphy TE, Costanzi JJ. Pseudotumorcerebri associated with pernicious anemia. Ann Intern Med 1969;70:777–82.10.7326/0003-4819-70-4-777Search in Google Scholar PubMed
15. Curry WT, Jr Butler WE, Barker FG. Rapidly rising incidence of cerebrospinal fluid shunting procedures for idiopathic intracranial hypertension in the United States, 1988–2002. Neurosurgery 2005;57:97–108.10.1227/01.NEU.0000163094.23923.E5Search in Google Scholar
16. Sugerman HJ, DeMaria EJ, Felton WL, Nakatsuka M, Sismanis A. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997;49:507–11.10.1212/WNL.49.2.507Search in Google Scholar
17. Hamdallah IN, Shamseddeen HN, Getty JL, Smith W, Ali MR. Greater than expected prevalence of pseudotumorcerebri: a prospective study. Surg Obes Relat Dis 2013;9:77–82.10.1016/j.soard.2011.11.017Search in Google Scholar PubMed
18. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, et al. Body mass index references for Turkish children. Acta Paediatr 2006;95:194–8.10.1080/08035250500334738Search in Google Scholar PubMed
19. Gokcay G, Furman A, Neyzi O. Updated growth curves for Turkish children aged 15 days to 60 months. Child Care Health Dev 2008,34:454–63.10.1111/j.1365-2214.2008.00813.xSearch in Google Scholar PubMed
20. Rosenfield RL, Cooke DW, Radovick S. Puberty and its disorders in the female. In: Sperling MA, editor. Pediatric endocrinology. Philadelphia, PA: Elsevier Saunders, 2007:530–610.10.1016/B978-141604090-3.50019-3Search in Google Scholar
21. Hughes IA. The testes: disorders of sexual differentiation and puberty in the male. In: Sperling MA, editor. Pediatric endocrinology. Philadelphia, PA: Elsevier Saunders, 2007:662–86.10.1016/B978-141604090-3.50021-1Search in Google Scholar
22. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555–76.10.1542/peds.114.S2.555Search in Google Scholar
23. Sinclair AJ, Burdon MA, Nightingale PG, Matthews TD, Jacks A, et al. Rating papilloedema: an evaluation of the Frisén classification in idiopathic intracranial hypertension. J Neurol 2012;259:1406–12.10.1007/s00415-011-6365-6Search in Google Scholar
24. Whiteley W, Al-Shahi R, Warlow CP, Zeidler M, Lueck CJ. CSF opening pressure: reference interval and the effect of body mass index. Neurology 2006;67:1690–1.10.1212/01.wnl.0000242704.60275.e9Search in Google Scholar
25. Smith JL. Whence pseudotumor cerebri? J Clin Neuroophthalmol 1985;5:55–6.Search in Google Scholar
26. Daniels SR, Greer FR. Committee on nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198–8.10.1542/peds.2008-1349Search in Google Scholar
27. Kurtoglu S, Hatipoglu N, Mazicioglu M, Kendirci M, Keskin M, et al. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010;2:100–6.10.4274/jcrpe.v2i3.100Search in Google Scholar
28. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:500–3.10.1542/peds.2004-1921Search in Google Scholar
29. Faz G, Butler IJ, Koenig MK. Incidence of papilledema and obesity in children diagnosed with idiopathic “benign” intracranial hypertension: case series and review. J Child Neurol 2010;25:1389–92.10.1177/0883073810364853Search in Google Scholar
30. Incecik F, Herguner MO, Altunbasak S. Evaluation of sixteen children with pseudotumor cerebri. Turk J Pediatr 2011;53:55–8.Search in Google Scholar
31. Phillips PH, Repka MX, Lambert SR. Pseudotumor cerebri in children. J AAPOS 1998;2:33–8.10.1016/S1091-8531(98)90107-0Search in Google Scholar
32. Genizi J, Lahat E, Zelnik N, Mahajnah M, Ravid S, et al. Childhood-onset idiopathic intracranial hypertension: relation of sex and obesity. Pediatr Neurol 2007;36:247–9.10.1016/j.pediatrneurol.2007.01.002Search in Google Scholar
33. Cinciripini GS, Donahue S, Borchert MS. Idiopathic intracranial hypertension in prepubertal pediatric patients: characteristics, treatment, and outcome. Am J Ophthalmol 1999;127:178–82.10.1016/S0002-9394(98)00386-9Search in Google Scholar
34. Hacifazlioglu EN, Yilmaz Y. Pseudotumour cerebri in children: etiological, clinical features and treatment modalities. Eur J Paediatr Neurol 2012;16:349–55.10.1016/j.ejpn.2011.09.002Search in Google Scholar PubMed
35. Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 1991;114:155–80.Search in Google Scholar
36. Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, et al. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014;71:693–701.10.1001/jamaneurol.2014.133Search in Google Scholar PubMed PubMed Central
37. Youroukos S, Psychou F, Fryssiras S, Paikos P, Nicolaidou P. Idiopathic intracranial hypertension in children. J Child Neurol 2000;15:453–7.10.1177/088307380001500706Search in Google Scholar PubMed
38. Distelmaier F, Sengler U, Messing-Juenger M, Assmann B, Mayatepek E, et al. Pseudotumor cerebri as an important differential diagnosis of papilledema in children. Brain Dev 2006;28:190–5.10.1016/j.braindev.2005.07.003Search in Google Scholar PubMed
39. Grant DN. Benign intracranial hypertension. A review of 79 cases in infancy and childhood. Archive Diseases of Child 1971;46:651–5.10.1136/adc.46.249.651Search in Google Scholar PubMed PubMed Central
40. Jiraskova N, Rozsival P. Idiopathic intracranial hypertension in pediatric patients. Clin Ophthalmol 2008;2:723–6.10.2147/OPTH.S1593Search in Google Scholar PubMed PubMed Central
41. Cizmecioglu FM, Etiler N, Gormus U, Hamzaoglu O, Hatun S. Hypovitaminosis D in obese and overweight school children. J Clin Res Pediatr Endocrinol 2008;1:89–96.10.4008/jcrpe.v1i2.43Search in Google Scholar PubMed PubMed Central
42. Buyukinan M, Ozen S, Kokkun S, Saz EU. The relation of vitamin D deficiency with puberty and insulin resistance in obese children and adolescents. J Pediatr Endocrinol Metab 2012;25:83–7.10.1515/jpem-2011-0426Search in Google Scholar PubMed
©2016 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- Decreased undercarboxylated osteocalcin in children with type 2 diabetes mellitus
- Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus
- Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India
- Increased GLP-1 response to oral glucose in pre-pubertal obese children
- Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
- Idiopathic postprandial hyperinsulinaemic hypoglycaemia
- Feeding, eating and behavioral disturbances in Prader-Willi syndrome and non-syndromal obesity
- Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study
- Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth
- Zoledronate for Osteogenesis imperfecta: evaluation of safety profile in children
- Elevated serum adiponectin is related to elevated serum ferritin and interleukin-6 in β-thalassaemia major children
- GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature
- Cystinosis in Eastern Turkey
- Microarray analysis of slipped capital femoral epiphysis growth plates
- Case Reports
- Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy: report of three cases from Iran
- Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl
- A novel splice site mutation in the GNPTAB gene in an Iranian patient with mucolipidosis II α/β
- Parent observed neuro-behavioral and pro-social improvements with oxytocin following surgical resection of craniopharyngioma
- A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl
Articles in the same Issue
- Frontmatter
- Original Articles
- Decreased undercarboxylated osteocalcin in children with type 2 diabetes mellitus
- Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus
- Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India
- Increased GLP-1 response to oral glucose in pre-pubertal obese children
- Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
- Idiopathic postprandial hyperinsulinaemic hypoglycaemia
- Feeding, eating and behavioral disturbances in Prader-Willi syndrome and non-syndromal obesity
- Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study
- Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth
- Zoledronate for Osteogenesis imperfecta: evaluation of safety profile in children
- Elevated serum adiponectin is related to elevated serum ferritin and interleukin-6 in β-thalassaemia major children
- GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature
- Cystinosis in Eastern Turkey
- Microarray analysis of slipped capital femoral epiphysis growth plates
- Case Reports
- Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy: report of three cases from Iran
- Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl
- A novel splice site mutation in the GNPTAB gene in an Iranian patient with mucolipidosis II α/β
- Parent observed neuro-behavioral and pro-social improvements with oxytocin following surgical resection of craniopharyngioma
- A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl