Endocrine Abstracts

Introduction: The prevalence of childhood obesity is continuing to increase, especially in more deprived areas. It is estimated that 28% of children are overweight or obese in England. Evidence has shown that obesity is associated with increased intracranial pressure (ICP) in adult and paediatric populations. We report three patients who presented with intracranial hypertension due to severe obesity.

Case 1: A fifteen-year-old girl presented with severe headaches and reduced vision following which she was noted to have papilledema. Her weight was 136.1 kg (+8.24 SDS) and BMI was 45.3 kg/m² (+3.81 SDS). She suffered from anxiety and found eating comforted her.

Case 2: A sixteen-year-old girl was noted to have asymptomatic papilledema following a routine optician review. Her weight was 114 kg (+5.98SDS) and BMI was 58.2 kg/m² (+4.46SDS). She had delayed puberty and her mother has type 2 diabetes mellitus.

Case 3: A nine-year-old girl presented with an eight week history of headaches, vomiting and diplopia and was noted to have papilledema. Her weight was 67.6 kg (+5.15SDS) and BMI was 35 kg/m² (+3.73SDS). Her mother has polycystic ovary syndrome and alopecia. None of the patients had features of Cushing’s syndrome and investigations including thyroid function, HbA1c, liver function and lipid profile were normal. Oral glucose tolerance revealed insulin insensitivity. Brain imaging ruled out other causes for raised ICP. All patients underwent a lumbar puncture and the opening pressures were greater than 40 mm H2O (one patient needed multiple lumbar punctures). The patients were started on Acetazolamide and were given advice about lifestyle modification to aid weight loss. Two patients were commenced on metformin which was not tolerated and subsequently discontinued.

Conclusion: We describe three patients who have severe complications due to obesity. The exact mechanism of raised ICP due to obesity is unclear but evidence has shown that weight loss will reduce ICP. Lifestyle changes and metformin therapy were not successful in our patients. They continue to gain weight which is likely to further compromise their long-term health. Newer therapeutic options are urgently needed to manage morbid obesity. It may also be beneficial to screen obese patients for papilledema as one of our patients was asymptomatic.