Adipokines in idiopathic intracranial hypertension

Idiopathic Intracranial Hypertension (IIH) is a disease that is usually seen in women of childbearing age and causes increased intracranial pressure that cannot be attributed to any cause. Commonly described symptoms include head and neck pain, tinnitus, dizziness, diplopia and vision loss. In patients with findings that can be clinically associated with increased intracranial pressure, the diagnosis is made by detecting the cerebrospinal fluid (CSF) opening pressure above 25cmH2O in the lumbar puncture performed after secondary causes of intracranial hypertension are excluded by neuroimaging methods. The treatment goal is based on preventing permanent symptoms, especially vision loss, by reducing CSF pressure. Studies in the literature show that the use of acetosalamide and weight loss through diet, in addition to unloading lumbar puncture applications, are effective in the treatment. Surgical techniques such as optic nerve sheath fenestration, CSF shunt, and transverse sinus stenting can also be applied in resistant patients. The fact that the majority of patients diagnosed with IIH are obese women, that weight gain worsens existing symptoms in patients with IIH, and that symptom improvement can be achieved with a 6% weight loss strengthens the relationship between the disease and obesity. Adipokines are hormones released from fat tissue and have roles in many different areas such as food intake, energy balance, lipid and glucose metabolism, cardiovascular system, inflammation and immune system modulation. The state of obesity can alter the amount of adipokines released by fat cells, which can trigger various metabolic and inflammatory conditions. The role of proinflammatory cytokines in IIH has been emphasized in some previous studies. However, there are not enough studies investigating the effect of adipokines, whose amounts change in obesity, on the pathogenesis of IIH through the inflammatory system. In addition, although there are many studies showing that adipokine levels vary in obesity, the role of adipokines in the possible common pathology between IIH and obesity has not been adequately investigated. In this study, visfatin, resistin, apelin and adipsin, which have never been examined in patients with IIH before; Additionally, serum levels of leptin and adiponectin, which have few studies on IIH, were compared in patients diagnosed with IIH and healthy controls. The IIH group was evaluated within itself in terms of symptoms, neurological and ophthalmological examination findings, fundus examinations, neuroimaging findings and CSF parameters. The IIH group was divided into 2 subgroups, those with obesity and those without, and IIH symptoms and neuroophthalmological examination findings, radiological findings, serum adipokine levels, CSF opening pressure and other serum and CSF parameters were compared between these 2 subgroups. Correlation analysis was performed between serum adipokine levels and other descriptive variables such as body mass index (BMI), age, lipid profile, CSF opening pressure, and CSF protein level in the case and control groups. In our study, we found that apelin, which has never been investigated in patients with IIH before, was statistically significantly higher in the IIH group than in controls. We think that the high level of apelin, which is assumed to have an anti-inflammatory effect, in our patient group may be a response of the immune system to the inflammatory processes that are likely to dominate the pathogenesis of IIH and an inflammation suppressive mechanism. All other adipokines were detected higher in patients with IIH than in the control group, but this difference was not statistically significant. No significant correlation was detected between BMI or CSF opening pressure and adipokine levels In order to reveal the relationship between adipokines and obesity and inflammatory system mediators in IIH, comprehensive studies need to be conducted in which the correlation of these adipokines with various cytokines is examined, and CSF and serum levels are compared between patients with IIH and healthy controls. Future studies in this field will help to clarify the possible effect of these hormones released from fat tissue on the pathogenesis of IIH.