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Benign intracranial hypertension with tetracycline therapy
Volume 93 Number 5
Editorial correspondence
2. Aynsley-Green A, Lucas A, and Bloom SR: The effect of feeds of different composition on enteroinsular hormone secretion in the first hours of life in human neonates, submitted for publication. 3. Aynsley-Green A, Bloom SR, Williamson DH, and Turner RC: Endocrine and metabolic response in the human newborn to.first feed of breast milk, Arch Dis Child 52:291, 1977. 4. Asptund K: Effects of postnatal feeding on the functional maturation of pancreatic islet B cells of neonatal rats, Diabetologia 8:153, 1972. 5. Gentz J, Persson B, Kellum M, Bengtsson G, and Thorell J: Effect of feeding on intravenous glucose tolerance and insulin response in piglets during the first day of life, Life Sci 10:137, 1971. 6. Lucas A, Bloom SR, and Aynsley-Green A: Metabolic and endocrine events at the time of the first feed of human milk in preterm and term infants, Arch Dis Child (in press).
Reply To the Editor: We congratulate Drs. Lucas, Bloom, and Aynsley-Green for the elegant study on the gut hormonal response to the first feed in term newborn and premature infants. The data certainly will contribute further to our understanding Of the role of gut hormones on food assimilation during the newborn period. Katherine C. King, M.D. Division of Neonatology Cleveland Metropolitan General Hospital 3395 Scranton Rd at Case Western Reserve University Cleveland, OH 44109 Robert Schwartz, M.D. Division of Pediatric Metabolism and Nutrition Brown University Providence, RI Peter A.J. Adam, M.D. Division of Pediatric Metabolism Cleveland Metropolitan General Hospital at Case Western Reserve University Cleveland, OH
Benign intracranial hypertension with tetracycline therapy To the Editor: In a recent issue of THE JOURNAL,Stuart and Litt 1 reported on tetracycline-associated intracranial hypertension as a complication of acne therapy in a female adolescent. Two other recent articles are of interest. Ohlrich and Ohlrich 2 presented a case report in which a 15-year-old girl developed intracranial hypertension following tetracycline therapy for acne. This report is in many respects similar to the one discussed by Stuart and Litt, including the fact
90 1
that in both patients the papilledema resolved two weeks after discontinuation of tetracycline. In a second pertinent article, Monaco et aP described a 16-year-old girl suffering from severe acne vulgaris. This patient was treated with minocycline and also developed benign intracranial hypertension. Minocycline is a semisynthetic tetracycline with increased cerebrospinal fluid permeability. Thus, benign intracranial hypertension is an adverse effect of not only tetracydines but semisynthetic tetracyclines as well. Walter M. Jay, M.D. Senior Resident Department of Ophthalmology Susan Jay, M.D. Senior Resident Department of Pediatrics The University of Chicago 950 E. 59th St. Chicago, IL 60637 REFERENCES
1. Stuart BH, and Litt IF: Tetracycline-associated intracranial hypertension in an adolescent: A complication of systemic acne therapy, J PEr)IATR92:679, 1978. 2. Ohlrich GD, and Ohlrich JG: Papilloedema in an adolesdue to tetracycline, Med J Aust 1:334, 1977. 3. Monaco F, Agnetti V, and Mutani R: Benign intracranial hypertension after minocycline therapy, Eur Neurol 17:48, 1978.
Reply To the Editor: We thank Drs. Jay and Jay for the addition of two new cases to the list of those thought to be related to tetracycline and its derivatives. The frequency of side effects from minocycline, especially dizziness and nausea, have largely precluded its use, formerly frequent, as chemoprophylaxis for close contacts of those with meningococcal disease? Intracranial hypertension, however, is still an uncommon side effect of this agent. Some light may be shed on the pathogenesis of tetracyclineinduced intracranial hypertension by a recently published effect of demeclocycline, the product of a mutant of the strain of Streptomyces aureofaciens, from which chlortetracycline was originally produced in 1948. The drug has been found to produce nephrogenic diabetes insipidus by interfering with the action of antidiuretic hormone (ADH) on the renal collecting-duct membrane, thus greatly altering its water permeability. ~ The effect has been utilized in the therapy of the syndrome of inappropriate antidiuretic hormone secretion? The process of CSF production, by active secretion of sodium by the choroid plexus followed by passive diffusion of water from plasma to CSF, is roughly analogous tO passive water reabsorption through the collecting-tubular membrane into the hypertonic renal medullary interstitium. It is intriguing to speculate that certain of the tetracyclines might influence membrane water permeability
Editorial correspondence
2. Aynsley-Green A, Lucas A, and Bloom SR: The effect of feeds of different composition on enteroinsular hormone secretion in the first hours of life in human neonates, submitted for publication. 3. Aynsley-Green A, Bloom SR, Williamson DH, and Turner RC: Endocrine and metabolic response in the human newborn to.first feed of breast milk, Arch Dis Child 52:291, 1977. 4. Asptund K: Effects of postnatal feeding on the functional maturation of pancreatic islet B cells of neonatal rats, Diabetologia 8:153, 1972. 5. Gentz J, Persson B, Kellum M, Bengtsson G, and Thorell J: Effect of feeding on intravenous glucose tolerance and insulin response in piglets during the first day of life, Life Sci 10:137, 1971. 6. Lucas A, Bloom SR, and Aynsley-Green A: Metabolic and endocrine events at the time of the first feed of human milk in preterm and term infants, Arch Dis Child (in press).
Reply To the Editor: We congratulate Drs. Lucas, Bloom, and Aynsley-Green for the elegant study on the gut hormonal response to the first feed in term newborn and premature infants. The data certainly will contribute further to our understanding Of the role of gut hormones on food assimilation during the newborn period. Katherine C. King, M.D. Division of Neonatology Cleveland Metropolitan General Hospital 3395 Scranton Rd at Case Western Reserve University Cleveland, OH 44109 Robert Schwartz, M.D. Division of Pediatric Metabolism and Nutrition Brown University Providence, RI Peter A.J. Adam, M.D. Division of Pediatric Metabolism Cleveland Metropolitan General Hospital at Case Western Reserve University Cleveland, OH
Benign intracranial hypertension with tetracycline therapy To the Editor: In a recent issue of THE JOURNAL,Stuart and Litt 1 reported on tetracycline-associated intracranial hypertension as a complication of acne therapy in a female adolescent. Two other recent articles are of interest. Ohlrich and Ohlrich 2 presented a case report in which a 15-year-old girl developed intracranial hypertension following tetracycline therapy for acne. This report is in many respects similar to the one discussed by Stuart and Litt, including the fact
90 1
that in both patients the papilledema resolved two weeks after discontinuation of tetracycline. In a second pertinent article, Monaco et aP described a 16-year-old girl suffering from severe acne vulgaris. This patient was treated with minocycline and also developed benign intracranial hypertension. Minocycline is a semisynthetic tetracycline with increased cerebrospinal fluid permeability. Thus, benign intracranial hypertension is an adverse effect of not only tetracydines but semisynthetic tetracyclines as well. Walter M. Jay, M.D. Senior Resident Department of Ophthalmology Susan Jay, M.D. Senior Resident Department of Pediatrics The University of Chicago 950 E. 59th St. Chicago, IL 60637 REFERENCES
1. Stuart BH, and Litt IF: Tetracycline-associated intracranial hypertension in an adolescent: A complication of systemic acne therapy, J PEr)IATR92:679, 1978. 2. Ohlrich GD, and Ohlrich JG: Papilloedema in an adolesdue to tetracycline, Med J Aust 1:334, 1977. 3. Monaco F, Agnetti V, and Mutani R: Benign intracranial hypertension after minocycline therapy, Eur Neurol 17:48, 1978.
Reply To the Editor: We thank Drs. Jay and Jay for the addition of two new cases to the list of those thought to be related to tetracycline and its derivatives. The frequency of side effects from minocycline, especially dizziness and nausea, have largely precluded its use, formerly frequent, as chemoprophylaxis for close contacts of those with meningococcal disease? Intracranial hypertension, however, is still an uncommon side effect of this agent. Some light may be shed on the pathogenesis of tetracyclineinduced intracranial hypertension by a recently published effect of demeclocycline, the product of a mutant of the strain of Streptomyces aureofaciens, from which chlortetracycline was originally produced in 1948. The drug has been found to produce nephrogenic diabetes insipidus by interfering with the action of antidiuretic hormone (ADH) on the renal collecting-duct membrane, thus greatly altering its water permeability. ~ The effect has been utilized in the therapy of the syndrome of inappropriate antidiuretic hormone secretion? The process of CSF production, by active secretion of sodium by the choroid plexus followed by passive diffusion of water from plasma to CSF, is roughly analogous tO passive water reabsorption through the collecting-tubular membrane into the hypertonic renal medullary interstitium. It is intriguing to speculate that certain of the tetracyclines might influence membrane water permeability