Idiopathic intracranial hypertension, hormones, and 11ß-hydroxysteroid dehydrogenases

Keira A Markey,¹ Maria Uldall,² Hannah Botfield,¹ Liam D Cato,¹ Mohammed A L Miah,¹ Ghaniah Hassan-Smith,¹ Rigmor H Jensen,² Ana M Gonzalez,¹ Alexandra J Sinclair<sup>1

1</sup>Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; ²Danish Headache Center, Clinic of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark

Abstract: Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provides an overview of pathogenic factors that could result in IIH with particular focus on hormones and the impact of obesity, including its role in neuroendocrine signaling and driving inflammation. Despite occurring almost exclusively in obese women, there have been a few studies evaluating the mechanisms by which hormones and adipokines exert their effects on ICP regulation in IIH. Research involving 11ß-hydroxysteroid dehydrogenase type 1, a modulator of glucocorticoids, suggests a potential role in IIH. Improved understanding of the complex interplay between adipose signaling factors such as adipokines, steroid hormones, and ICP regulation may be key to the understanding and future management of IIH.

Keywords: 11beta-hydroxysteroid dehydrogenase type 1, steroid and adipokines, obesity, leptin