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ISSN: 2157-7536
Journal of Steroids & Hormonal Science
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Potential Side-Effects of CSC Systemic Approach

Nelli Roosipuu1*, Alina Vijulie2, Rosa Dolz-Marco3 and Roberto Gallego-Pinazo4

1Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain

2Tartu University Eye Clinic, Estonia

3Lucian Blaga University of Medicine, Sibiu, Romania

4Retics Oftared (RD12/0034), Prevention, Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology, Institute of Health Carlos III, Madrid, Spain

*Corresponding Author:
Nelli Roosipuu
Unit of Macula, Department of Ophthalmology
University and Polytechnic Hospital La Fe, Valencia, Spain
Tel: +372 56654324
E-mail: [email protected]

Received date: October 28, 2015; Accepted date: November 27, 2015; Published date: November 30, 2015

Citation: Roosipuu N, Vijulie A, Marco RD, Pinazo RG (2015) Potential Side-Effects of CSC Systemic Approach. J Steroids Horm Sci 6:162. doi:10.4172/2157-7536.1000162

Copyright: © 2015 Roosipuu N, et al.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Introduction

Central serous chorioretinopathy (CSC) is characterized by the development of serous retinal detachment typically involving the macular area [1,2]. It may be recurrent in 30-50% of cases, leading to significant visual impairment [2]. Its etiopathogenesis remains uncertain, with a variety of genetic and environmental factors possibly involved [1,2]. Among these, the role of steroids has arisen as a potential therapeutic target with the use of mineralocorticoid inhibitors like spironolactone or eplerenone [1,3].

The role of corticosteroids seems to be important in developing CSC. It has been found in CSC patients to have higher endogenous corticosteroid level or to have hypercortisolism due to a treatment of corticosteroids [2].

Case Description

Herein we report a case of a 49-year-old man diagnosed with chronic CSC in his right eye three years earlier. His visual acuity was 20/30. The optical coherence tomography images evidenced a flat serous foveal detachment with outer nuclear layer atrophy. Given the chronicity and the persistence of subretinal fluid, treatment with laser photocoagulation, and intravitreal injections of ranibizumab and aflibercept had been performed with no significant benefit. After two years of follow-up the patient initiated treatment with oral spironolactone. In addition to the lack of efficacy of this approach, he developed mastodynia, nipple discharge and erectile dysfunction. A mammography failed to evidence any structural disturbance. Spironolactone was therefore discontinued and these symptoms resolved within 48 hours.

Discussion

Spironolactone is widely used in essential antihypertensive therapy, hyperaldosteronism, cirrhosis, congestive heart failure, nephrotic syndrome or hypokalemia. Gynecomastia is a frequent side-effect (10%) given its antiandrogenic effect, thus leading to increased free estradiol and total estradiol [3-6].

Conclusion

Ophthalmologists have traditionally been considered “earlyadopters” of new therapeutic agents or approached with lack of first level or scientific evidence. Actually spironolactone is widely used for chronic CSC although no large clinical trials has been conducted [7]. In our opinion, it is highly relevant to be familiar with the potential sideeffects of systemic therapies and to inform patients about these when prescribing off-label medications for ocular conditions.

References

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