Pseudotumor Cerebri Associated with Leuprolide Acetate for Central Precocious Puberty-Case Report

This article represents the fourth case in literature of an association between pseudotumor cerebri (PTC) and leuprolide acetate, the first with precocious puberty and severe visual loss. A 9-year-old girl with precocious puberty was treated with a once-monthly dose of leuprolide acetate (3.75 mg) for three months. In the 4th month of treatment, it was decided to increase the dosage of leuprolide acetate to 11.25 mg in once-quarterly doses. After 1 month, she complained of holocranial headache, transient visual obscuration followed by progressive visual loss. After 6 months, she persisted with holocranial headache and progressive visual loss associated with ocular deviation. Neuro-opthalmological examination revealed severe visual loss and bilateral papilledema. Cerebrospinal fluid (CSF) analysis showed opening pressure of 45 cm H2O. The most likely diagnosis was PTC associated with leuprolide acetate. Treatment was started immediately with oral acetazolamide and leuprolide was discontinued. Acetazolamide was discontinued for having induced metabolic acidosis. A ventriculoperitoneal shunt was performed to control intracranial pressure as an alternative to acetazolamide treatment. The follow-up of 18 months showed CSF pressure of 14 cm H2O, stabilization of visual acuity and resolution of papilledema. There appears to be a causal relationship between the onset of leuprolide acetate with the development of PTC. Children should have a complete ophthalmic evaluation if they report headache or visual disturbances after administration of leuprolide acetate.