Pınar AKGÜL, Müge ÖZSAN, Remzi YİĞİTER, Aylin AKÇALI, AYŞE MÜNİFE NEYAL, Sema GEYİK, Mustafa YILMAZ, Mehmet Ali ELÇİ

A case of pseudotumor cerebri associated with idiopathic hypopara-thyroidism and vitamin B12 deficiency

İdiopatik hipoparatroidizm, düşük parathormon seviyesi ile birlikte hipokalsemi, hiperfosfatemi ve D vitamini eksikliğinin görüldüğü ve nadiren psödötümör serebri etyolojisinde yer alan heterojen bir hastalıktır. Otuz sekiz yaşında kadın hasta kliniğimize baş ağrısı ve bulanık görme şikayeti ile başvurdu. Yapılan nörolojik muayenede solda daha belirgin olmak üzere bilateral papil ödemi mevcuttu. Hastanın kranial görüntülemesi normal sınırlarda olup yapılan lomber ponksiyonda (LP) beyin omurilik sıvı (BOS) basıncı 270 mmH2O olarak ölçüldü ve psödötümör serebri tanısı konuldu. Hastanın laboratuvar tetkiklerinde; düşük parathormon (PTH) ve vitamin D düzeyi ile birlikte hipokalsemi, hiperfosfatemi saptandı ve idiopatik hipoparatrodizm tanısı konularak tedavisi düzenlendi. Takiplerde BOS basıncının düşmediği gözlendi ve tekrarlanan laboratuvar tetkiklerinde vitamin B12 düzeyinde düşme olduğu saptanarak tedaviye vitamin B12 eklendi. Yapılan kontrol LP lerde hastanın kan kalsiyum ve vitamin B12 düzeyindeki artışa paralel olarak BOS basıncının düştüğü (190 mmH2O) gözlendi.

İdiopatik hipoparatiroidizm ve B12 eksikliğinin eşlik ettiği bir psödotümör serebri vakası

Idiopathic hypoparathyroidism is a heterogeneous disorder rarely involved in the etiology of pseudotumor cerebri, and characterized by low levels of parathormone accompanying hypocalcemia, hyperphosphatemia and vitamin D deficiency. A 38-year-old female patient was admitted to our clinic with the complaints of headache and blurred vision. Her neurological examination revealed bilateral papilledema which was more prominent in the left eye. Cranial magnetic resonance imaging findings of the patient were within normal ranges and cerebrospinal fluid (CSF) pressure was 270 mmH2O which was measured through a lumbar puncture (LP), then the patient was diagnosed with pseudotumor cerebri. Laboratory assessment revealed low parathormone (PTH) and vitamin D levels accompanying hypocalcemia and hyperphosphatemia; and the patient was diagnosed with idiopathic hypoparathyroidism. In her follow- up, no decline was observed in CSF pressure and in the repeated laboratory assessments, a decrease in the vitamin B12 level was observed, thus vitamin B12 supplementation was added to her treatment. In control LPs, CSF pressure (190 mmH2O) decreased as the blood calcium (Ca) and vitamin B12 levels increased

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