Fraud Case Report : Hydrocortisone + Acetazolamide

[Mr Joe]

I am trying to dig Dr. Peat mention of Acetazolamide to help retain CO2.

I've found a recent article :
"We report a novel presentation of deficit in anterior pituitary function with variable immune deficiency (DAVID) syndrome in a healthy young girl presenting in Addisonian crisis with raised intracranial pressure."
The concluion was : "The patient's symptoms improved with hydrocortisone replacement and acetazolamide, but the raised intracranial pressure recurred after acetazolamide was discontinued.".
Should this conclusion not induce doctors pointing why acetazolamide stopped reduced the intracranial pressure ? My guess is that Acetazolamide will help increase CO2 and thus, as Dr. Peat mentionned CO2 will probably stabilize nerves, retain sodium, increase thyroid and reduce nitric oxide. Also I've emailed Dr. Peat about intracranial pressure and he sent me a research document on how estrogen excess would cause that as well.

But the most interresting thing was the conclusion :

"This case demonstrates pseudotumour cerebri as a novel neurological presentation of DAVID syndrome, highlights the rare association between adrenal insufficiency and intracranial hypertension, and shows the challenges in diagnosing isolated ACTH deficiency. We emphasise that cortisol should be checked in pre-pubertal children with pseudotumour cerebri and a diagnosis of DAVID syndrome considered in those presenting with low cortisol and neurological symptoms."

Why combining hydrocortisone with Acetazolamide ? Why not trying Acetazolamide + Methylene blue for example ? Are they trying to say "at the end, the problem was probably that this young lady is not having enough cortisol ?

The search for a unifying diagnosis involving neurological, endocrine and immune dysfunction: a case report of a novel presentation of DAVID syndrome - PubMed

This case demonstrates pseudotumour cerebri as a novel neurological presentation of DAVID syndrome, highlights the rare association between adrenal insufficiency and intracranial hypertension, and shows the challenges in diagnosing isolated ACTH deficiency. We emphasise that cortisol should be...

pubmed.ncbi.nlm.nih.gov

 

[Mr Joe]

Another new (November 2022) showing how CO2 could be THE key for brain relaxation :

Case report: Meningoencephalocele and recurrent bacterial meningitis in chronic idiopathic intracranial hypertension​

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"Case presentation: This study presents a case of a patient with a decade of recurrent meningitis. With clinical symptoms and imaging examination with chronic idiopathic intracranial hypertension, this patient was diagnosed with meningoencephalocele. With the treatment of acetazolamide to decrease CSF product, the patient had no recurrence of meningitis over the 6-months follow-up period.

Conclusion: In patients with recurrent intracranial infections but no history of immunodeficiency, cranial trauma, or neurosurgery, the possibility of meningitis should be considered appropriately, even in the absence of CSF otorrhea or rhinorrhea."

I remember an article where Aspirin was also used to treat some sort of meningitis. Maybe increasing CO2 by using aspirin was also part of the anti-inflammatory and metabolism boost similar to Acetazolamide. Considering that Acetazolamide is a diuretic, should someone using acetazolamide increase salt intake to compensate the loss in urine ? Any insight appreciated !

Case report: Meningoencephalocele and recurrent bacterial meningitis in chronic idiopathic intracranial hypertension - PubMed

In patients with recurrent intracranial infections but no history of immunodeficiency, cranial trauma, or neurosurgery, the possibility of meningitis should be considered appropriately, even in the absence of CSF otorrhea or rhinorrhea.

pubmed.ncbi.nlm.nih.gov

 

[Mr Joe]

Another interessting article about Acetazolamide :

Symptomatic intracranial hypertension in an adult patient with spinal muscular atrophy and arachnoid cysts receiving nusinersen - PubMed

In patients with spinal muscular atrophy (SMA) headache after intrathecal administration of nusinersen is usually attributed to post-lumbar puncture syndrome. However, lumbar puncture opening pressure (LOP) has also been reported to be increased in children with SMA, both before and after...

pubmed.ncbi.nlm.nih.gov

"Symptoms resolved after 8 weeks of treatment with repeated lumbar punctures and acetazolamide. This case raises the possibility of intracranial hypertension as a complication of nusinersen therapy although arachnoid cysts represent another risk factor for intracranial hypertension. We recommend that patients suffering from headache after nusinersen injections should not only be questioned and examined for symptoms suggestive of post-lumbar puncture syndrome, but also intracranial hypertension."

Importance of CO2 on the brain relaxation is again proved. Can someone understand what could have made Albumin, IgG or IgA increase as well ?