Treatment dilemma in an adolescent girl with idiopathic intracranial hypertension presenting with abnormal uterine bleeding and severe anemia

Authors

  • Prabha Agrawal Department of Obstetrics and Gynaecology, Hyderabad, Telangana, India
  • Rahul Agrawal Department of Internal Medicine, Hyderabad, Telangana, India
  • Deepti Mehta Department of Ophthalmology, Hyderabad, Telangana, India
  • Pragna Kamjula Department of Obstetrics and Gynaecology, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20221305

Keywords:

Abnormal uterine bleeding, Adolescents, Idiopathic intracranial hypertension, Progesterone

Abstract

Abnormal uterine bleeding (AUB), specifically heavy menstrual bleeding (HMB) is a frequent complaint for adolescents. Idiopathic intracranial hypertension (IIH) is a syndrome of raised intracranial pressure, in the absence of any evidence of an intracranial space occupying lesion. Female sex, obesity and polycystic ovarian disease are known risk factors associated with IIH. This case report depicts the unusual case of an 18-year-old girl with IIH who presented with HMB for 28 days with severe anemia with Hb of 5.5 gm%. Urgent ophthalmic and neurological review was taken in view of IIH. Prompt treatment of AUB was done with blood transfusion, hemostatics, and orally administered iron supplements. Despite medical treatment for AUB, patient continued to bleed and hence after multidisciplinary discussion and informed consent she was started on low dose progesterone. Symptoms improved rapidly and she was discharged in a stable condition with tapering doses of medication and regular follow- up advice. Treatment of AUB in adolescents with IIH is a dilemma for physicians. To date, there is no direct evidence suggesting either implantable or oral contraceptives as a cause for IIH but few studies have closely linked oestrogen containing oral contraceptive pills and some levonorgestrel implants in IIH and hence these should be avoided.

Author Biographies

Prabha Agrawal, Department of Obstetrics and Gynaecology, Hyderabad, Telangana, India

Consultant , Department of Obstetrics and Gynaecology

Rahul Agrawal, Department of Internal Medicine, Hyderabad, Telangana, India

Consultant, Department of Internal Medicine

Deepti Mehta, Department of Ophthalmology, Hyderabad, Telangana, India

Consultant, Department of Ophthalmology

Pragna Kamjula, Department of Obstetrics and Gynaecology, Hyderabad, Telangana, India

Senior Resident, Department of Obstetrics and Gynaecology

References

Zahra A. Idiopathic intracranial hypertension after hysteroscopic evaluation of abnormal uterine bleeding. Journal of Evolution of Medical and Dental Sciences. 2019;8(3):223.

Elmaoğulları S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol. 2018;10(3):191-7.

Ivancic R, Pfadenhauer K. Pseudotumor Cerebri after Hormonal Emergency Contraception. European Neurology. 2004;52(2):120-1.

Wall M. Update on Idiopathic Intracranial Hypertension. Neurol Clin. 2017;35(1):45-57.

Archer EL. Idiopathic intracranial hypertension. Available at: https://www.medlink.com/articles/idiopathic-intracranial-hypertension. Accessed on 13 November 2021.

Qiao L, Wei Y. Familial Idiopathic Intracranial Hypertension in Two Non-obese Chinese Sisters. Front Neurol. 2020;10.

Ko MW, Liu GT. Pediatric Idiopathic Intracranial Hypertension (Pseudotumor Cerebri). Horm Res Paediatr. 2010;74:381-9.

Catherine H, Susan MP. Metabolic Concepts in Idiopathic Intracranial Hypertension and Their Potential for Therapeutic Intervention. J Neuro-Ophthalmol. 2018;38(4):522-30.

Markey KA, Uldall M, Botfield H. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases. J Pain Res. 2016;9:223-32.

Chan J. Idiopathic intracranial hypertension associated with depot medroxyprogesterone. Eye. 2006;20:1396-7.

Valenzuela RM, Rai R, Kirk BH. An Estimation of the Risk of Pseudotumor Cerebri among Users of the Levonorgestrel Intrauterine Device. Neuroophthal. 2017;41(4):192-7.

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Published

2022-04-27

Issue

Section

Case Reports