Growth Hormone Treatment and Papilledema: a Prospective Pilot Study.

OBJECTIVE To investigate the incidence of pseudotumor cerebri syndrome in children treated with growth hormone in a paediatric hospital and to identify risk factors of this complication. METHODS Prospective pilot study of paediatric patients treated with growth hormone, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later. RESULTS 289 patients were included: 244 had a growth hormone deficiency, 36 had short stature associated with small for gestational age, six had a mutation in the SHOX gene and three had Prader-Willi Syndrome. Five patients developed papilledema, all were asymptomatic and had a growth hormone deficiency: one had a craniopharyngioma, two a polymalformative syndrome associated with hypothalamic-pituitary axis anomalies, one patient a non-specified genetic disease with hippocampal inversion and one patient with normal magnetic resonance imaging who had developed a primary pseudotumor cerebri syndrome years before. CONCLUSIONS Growth hormone treatment is a cause of pseudotumor cerebri syndrome. In our series, at risk patients had growth hormone deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosome diseases. Fundus examination should be systematically screened in all patients in this at-risk group irrespective of the presence or not of symptoms.