Case Report: An IIH Induced Endometriosis that Diagnosed by OCT, and Revealed Ten Years Dilemma of HPG Axis Dysfunction due to Pressure Effect of CSF on Pituitary Stalk

¹Clinical Research Development Center of Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

²Department of Biological Sciences, Tarbiat Modares University, Tehran, Iran

³Department of Cognitive Science Studies, Shahid Beheshti University, Tehran, Iran

⁴Department of Cognitive Modeling, Institute for Cognitive Science Studies, Tehran, Iran

⁵Molecular Biology and Genetics Department, Engineering and Natural Science Faculty, Istinye University, Istanbul, Turkey

⁶Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁷TRUST/FALCON RAY Imaging (X-Ray and Visible Spectrum) Tehran, Iran

⁸Department of Reproductive Biology, Academic Center for Education, Culture and Research, Qom branch, Qom, Iran

⁹Director, Department of Ophthalmology, Acacia Medical Center, Dubai, UAE

¹⁰Director of Neuro-Ophthalmology, San Jose Eye and Laser Medical Center, California, USA

*Corresponding author: Bita Shalbafan, Clinical Research Development Center of Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tel: +989161119656; E-mail: [email protected].

Received Date: December 19, 2022

Published Date: February 10, 2023

Citation: Shalbafan B, et al. (2023). Case Report: An IIH Induced Endometriosis that Diagnosed by OCT, and Revealed Ten Years Dilemma of HPG Axis Dysfunction due to Pressure Effect of CSF on Pituitary Stalk. Mathews J Neurol. 7(1):23.

Copyrights: Shalbafan B, et al. © (2023).

ABSTRACT

A 50 years old female patient stepped into Neurology practice, who had been suffering from intractable headaches and followed up for 10 years. At the meantime, she was secondarily assessed by Endometriosis stage-II. Meanwhile, the lab workup did not reflect much of an off the chart hormonal study, Anemia was a point of consideration. Although treatment for Anemia was successfully fulfilled, no progression was noted with mending Endometriosis symptoms and headaches. To that end, the patient was referred to Neurologist. She underwent a brain MRI study and was reported by empty Sella as an incidental finding. As a result, fundus photography was performed to check for papilledema, where no significant findings were reported. However, thus Empty Sella was in combination with severe headaches, Optical Coherence Tomography (OCT) was employed to have a closer look into her Optic Disc. OCT findings of the Retinal Nerve Fiber Layer (RNFL) over the Circumpapillary Tomogram and choroidal folds, concluded a micro-papilledema that finally provided an explanation for those chronic headaches. To that end, the patient went through a Lumber Puncture (LP), where an intracranial pressure (ICP) of 29 cmH2O was measured, CSF exam showed no cells and so normal Biochemical analysis. She was eke prescribed by Acetazolamide and constantly studied through the OCT, in order to comprehend the ICP reduction based on RNFL thickness decrease and clinical review. Along with ICP reduction, improvements were observed in Endometriosis symptoms. Such recovery was likewise perceived in headaches to occur in lower frequencies, duty cycles and severities. Research has indicated the correlation between IIH and the occurrence of Gynecologic disorders, including Endometrial issues and Polycystic Ovarian Syndrome (PCOS). Androgen excess has been discussed to be prevalent among women with IIH. An NIH fundamental diagnostic criterion for PCOS, demands a clinical or biochemical element of androgen excess. Otherwise, The ICP elevation by IIH impacts on Pituitary Stalk, which causes the Hypothalamic-Pituitary-Gonadal Axis (HPG Axis) to become misaligned with respect to its mechanism. The HPG Axis encounters the unified functionality of those included glands. Once the Pituitary Stalk withstands an Empty Sella, changes in Gonadotropin Releasing Hormone (GnRH), would leave metabolic impacts on Endometriosis development. The additional malfunctioning among the HPG Axis would cause alternations in Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which both contribute to Endometriosis. Moreover, the HPG Axis, as a unified hormonal system to be disturbed, would drawback a lack of balance in Estradiol Progesterone (EP). Such impairment would transform the Uterine tissue and could therefore influence the progression of Endometriosis. Gynecologists are hence recommended to consider the probability of IIH or any condition that elevates the ICP; meanwhile experiencing patients’ long-term lack of response to Endometriosis treatments, in combination with headaches. Thus, the IIH or any ICP elevating condition could be easily diagnosed in their early stages and monitored by simple and non-invasive studies of Optic Disc Optical Coherence Tomography (Disc OCT). Therefore, an OCT study could be a cost-effective approach to maintain the quality of care for women with Endometriosis, who may alternatively be tolerated by IIH, even in its early stages.

Keywords: Endometriosis, Idiopathic Intracranial Hypertension (IIH), Optic Coherence Tomography (OCT), Headache.