Idiopathic intracranial hypertension: A possible complication in the natural history of advanced prostate cancer

Abstract

Abbreviations & AcronymsAbstract: Idiopathic intracranial hypertension is a variety of intracranial hypertension that is extremely rare in men. Obesity and hypogonadism are the most important predictive factors. Etiological hypotheses include increased central venous pressure, and various hormonal and metabolic changes commonly found in obese patients. We described the case of an obese man with prostate cancer who showed a consistent bodyweight increase during treatment with taxanes and prednisone. He was hospitalized because of a severe loss of vision as a consequence of idiopathic intracranial hypertension. A complete symptom remission was obtained after 3 weeks of anti-edema therapies (steroids, acetazolamide). Castration-resistant prostate cancer is a risk factor for idiopathic intracranial hypertension. Long-term androgen deprivation therapy, bodyweight increase, and fluid retention during chronic steroid administration and taxane chemotherapy might favor the disease onset. This severe complication has a good outcome, and should be suspected in the presence of symptoms and signs of intracranial hypertension.

A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics

“…Intriguingly, men with IIH are more likely to have symptoms of androgen deficiency, such as erectile dysfunction and reduced libido (29). Additionally, men can develop an IIH-like condition (Pseudotumor cerebri) in the setting of low testosterone attributed to gonadotropin deficiency or administration of androgen deprivation therapy (30).…”

What Do Transgender Patients Teach Us About Idiopathic Intracranial Hypertension?

“…16 It is notable that IIH has also been reported in men with hypogonadism, with cases described in men after androgen deprivation therapy for prostate cancer. 17 Additionally, men with IIH are more likely to have symptoms associated with testosterone deficiency. 18 This raises the prospect of a “pathophysiological window” of circulating testosterone levels in humans, with levels above the normal reference range for females, but below the normal reference range for men, associated with metabolic perturbations, including increased visceral fat deposition, insulin resistance, and fatty liver disease.…”

Eye Conditions in Women

“…141 There are also case reports of men treated with androgen deprivation therapy for prostate cancer who have developed IIH after induction of hypogonadism. 142…”

“…141 There are also case reports of men treated with androgen deprivation therapy for prostate cancer who have developed IIH after induction of hypogonadism. 142 Idiopathic intracranial hypertension follows a paradoxical pattern similar to autoimmune disease: Women are affected in greater numbers, but men are affected more severely. 143 One possible explanation for this seeming paradox was posited by Hornby et al There may be a window of abnormal serum testosterone levels that is shared by men with androgen deficiency and women with androgen excess and in which there is an increased risk of developing IIH.…”