Benign intracranial hypertension associated with acromegaly

This is the first reported case of benign intracranial hypertension (BIH) occurring with acromegaly and resolving after successful treatment of a growth hormone-secreting pituitary adenoma. BIH has been reported with recombinant human growth hormone (rhGH) therapy of GH deficient patients and insulin-like growth factor I (IGF-I) treatment of growth hormone (GH) insensitivity (Laron syndrome) in children. We postulate that the proposed mechanism causing BIH in rhGH-treated children and in acromegaly results from increased cerebrospinal fluid production from the choroid plexi secondary to elevated cerebrospinal fluid growth hormone concentrations that trigger local IGF-I secretion and activation of IGF-I receptors.

Idiopathic sclerosing orbital inflammation

Objective: To perform a multicenter review of the clinical features and treatment of 31 patients with idiopathic sclerosing orbital inflammation. Methods: We included all patients with histologically confirmed idiopathic sclerosing orbital inflammation from 5 regional orbital centers. We reviewed the case notes to determine the clinical presentation, diagnostic features, and response to treatment. The main outcome measures were duration and nature of symptoms, anatomical location of disease, histopathological findings, treatment modalities, treatment efficacy and adverse effects, and final clinical status. Results: We included 13 male and 18 female patients ranging in age from 7 to 83 years. The average duration of symptoms at presentation was 13.4 months. There was a predilection for the lateral and superior quadrants. Thirteen patients had apical disease, and 4 had extraorbital involvement. Histopathological findings invariably showed sclerosis associated with a sparse mixed cellular infiltrate. Twenty- seven patients were treated with oral prednisolone, response to which was good in 9 patients, partial in 11, and poor in 7. Six patients were treated with a second- line immunosuppressive agent, and 6 received radiotherapy. The response to radiotherapy was generally poor. Conclusions: Idiopathic sclerosing orbital inflammation is a rare condition that can be difficult to diagnose and manage. Early intervention with immunosuppression in the form of corticosteroids combinedwith secondline agents can result in control and even regression of the disease.