Endocrine Abstracts

JOINT3764

Introduction: Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) without an identifiable cause. It primarily affects obese women and is associated with headaches, papilledema, and visual disturbances. The prevalence of IIH has increased with rising obesity rates. Weight loss remains the mainstay of treatment, and glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as semaglutide, have demonstrated effectiveness in metabolic control and weight reduction.

Methods: We retrospectively analyzed four female patients diagnosed with IIH who received semaglutide as part of their weight loss and ICP management strategy. The BMI before and after therapy, headache frequency and severity, and changes in visual symptoms were documented.

Results: Patient 1: A 38-year-old woman with BMI 28.7 kg/m² at baseline presented with perimenstrual migraines, visual impairment, and tinnitus. After 12 months of semaglutide therapy, her BMI reduced to 27.3 kg/m². Her monthly headache days (MHD) decreased from 30 to 15, with no visual disturbances. Patient 2: A 39-year-old woman with a history of gastric bypass and obesity (BMI 33.79 kg/m²) experienced persistent holocephalic pressure and severe headaches. Following 10 months of semaglutide therapy, her BMI dropped to 27.3 kg/m², and MHD decreased from 30 to 15, with an intensity reduction from 7/10 to 3–5/10. Patient 3: A 48-year-old woman with hypertension and diabetes was diagnosed with IIH and papilledema (BMI 42 kg/m²). After 6 months of semaglutide therapy, she lost 6 kg (BMI 40.4 kg/m²), and her headaches completely resolved. Acetazolamide therapy was maintained, and no recurrence of symptoms was noted. Patient 4: A 34-year-old woman diagnosed with IIH in 2021 had a BMI of 35.3 kg/m² (96 kg, 165 cm). Due to polycystic ovary syndrome (PCOS), she was started on semaglutide, spironolactone, and metformin in 2022. After 18 months of therapy, she experienced significant weight loss (BMI reduced to 28.3 kg/m², 77 kg) and complete resolution of headaches. At her January 2025 follow-up, she was pregnant with recurrent headaches.

Discussion: All four patients demonstrated significant weight loss, headache reduction, and improved quality of life with semaglutide therapy. BMI reductions ranged from 6.3% to 25%. No patients exhibited progressive visual impairment, and two achieved complete headache resolution. GLP-1RAs promote weight loss and may directly affect intracranial pressure via GLP-1 receptors in the choroid plexus, supporting their potential role in IIH management.

Conclusion: Semaglutide represents a promising adjunct therapy for IIH, weight reduction and headache relief, potentially impacting intracranial pressure regulation.