Testosterone cipionate
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First report of secondary pseudotumour cerebri: case report A 23-year-old transgender male developed secondary pseudotumour cerebri during treatment with testosterone cipionate during gender reassignment management [duration of treatment to reaction onset not stated]. The man, who was receiving weekly IM testosterone cipionate [dosage not stated], presented with a 2-month history of persistent headache. The pain was non-localised, worse in the morning, and exacerbated in supine position, by coughing or yawning. He had also noted black spots in his vision and transient bilateral visual loss, lasting for less than 1 minute, during the previous 2 weeks; visual symptoms were more pronounced in the peripheral visual field and worsened with positional change. On examination, the man was found to have a body mass index (BMI) of 27.05, and visual acuities of 6/6 in both eyes. Fundoscopy revealed florid bilateral disc oedema, haemorrhages and hard exudates; bilateral papilloedema was confirmed by optical coherence tomography (OCT). An MRI revealed Chiari I formation, which was later considered insignificant. Lumbar puncture disclosed an opening pressure of 45cm H2O, and normal CSF cell counts, protein and glucose levels. Findings were consistent with idiopathic intracranial hypertension. The man started receiving acetazolamide and was advised to half his testosterone dose; at that time, his testosterone level was normal (743). Repeat fundoscopy and OCT showed marked improvement 1 month later, and he reported complete resolution of visual symptoms. At 2 months, his total testosterone and estradiol levels were determined to be 591 and 53, respectively [units not stated]; his estradiol level had decreased to 42 four months later. Follow-up at 3 and 5 months showed progressive improvement and eventual resolution of his symptoms and papilloedema; additionally, his BMI decreased to 26.18. Author comment: "Oestrogen can promote thrombotic intracranial CSF outflow obstruction, leading to increased intracranial pressure and papilloedema of [idiopathic intracranial hypertension]. . . We postulated that our patient may have had elevated estradiol levels from peripheral conversion of injected testosterone." Mowl AD, et al. Secondary pseudotumour cerebri in a patient undergoing sexual reassignment therapy. Clinical & Experimental Optometry 92: 449-453, No. 5, Sep 801158156 2009 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of pseudotumour cerebri associated with testosterone cipionate.The WHO ADR database did not contain any reports of benign intracranial hypertension associated with testosterone cipionate.
0114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 9 Jan 2010 No. 1283
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