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Obesity, 11β-hydroxysteroid dehydrogenase and metabolic changes in the pathogenesis of idiopathic intracranial hypertension

Sinclair, Alexandra (2010)
Ph.D. thesis, University of Birmingham.

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Abstract

Idiopathic intracranial hypertension (IIH) is a blinding condition amongst the young obese female population characterised by elevated intracranial pressure (ICP). The aetiology of IIH is not known and, as highlighted in the 2005 Cochrane review, an evidence base for treatment has not been established, although weight loss is frequently advocated. Obesity is associated with dysregulation of cortisol metabolism by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Additionally, 11β-HSD1 has a role in the regulation of intraocular pressure. This thesis hypothesised that 11β-HSD1 is involved in the aetiology of IIH and examined the roles of obesity, 11β-HSD1 and metabolic changes in the pathogenesis and treatment of IIH. We demonstrated that ICP regulating structures (choroid plexus and arachnoid granulation tissue), are potential glucocorticoid target tissues expressing 11β-HSD1. Metabolomic analysis identified a unique biofluid metabolite biomarker profile, with potential implications for IIH pathogenesis. We established the therapeutic efficacy of weight loss in IIH (improving headaches, papilloedema and ICP) and provided evidence that the beneficial effects may relate to alterations in the glucocorticoid profile driving 11β-HSD1 and potentially, 5α reductase. These studies have started to address the important issues of causation and treatment in IIH and provide avenues for future research into this complex condition.

Type of Work:Ph.D. thesis.
Supervisor(s):Rauz, Saaeha and Walker, Elizabeth and Stewart, Paul M and Burdon, Michael
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Immunity and Infection, Academic Unit of Ophthalmology
Subjects:RE Ophthalmology
R Medicine (General)
QP Physiology
Institution:University of Birmingham
ID Code:1013
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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