The Role of Exenatide, a Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist, in Idiopathic Intracranial Hypertension and Polycystic Ovary Syndrome: A Case Report.

Abstract

Idiopathic intracranial hypertension (IIH) and polycystic ovary syndrome (PCOS) are strongly associated with obesity in women of reproductive age. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been extensively reported to facilitate weight loss through central satiety. Emerging evidence demonstrates additional benefits of GLP-1 RAs. Exenatide exerts direct effects on choroid plexus receptors, reducing cerebrospinal fluid (CSF) secretion and intracranial pressure (ICP), and on the ovary, enhancing follicular maturation, restoring ovulation, and improving fertility outcomes in PCOS. A 29-year-old woman with PCOS was referred from gynecology for assessment of intermittent visual blurring and chronic headaches. Ophthalmic examination revealed normal monocular visual acuity of 6/5 in each eye but reduced binocular vision of 6/12, associated with double vision. She also reported a weight gain of 15 kg over eight months. Fundoscopy was unremarkable, with no optic disc swelling. IIH without papilledema (IIHWOP) was diagnosed based on magnetic resonance imaging showing an enlarged pituitary fossa, partial empty sella, and optic nerve sheath dilatation, with lumbar puncture confirming a raised opening pressure of 280 mmH₂O and normal CSF. Initial treatment with acetazolamide was discontinued due to intolerance. Exenatide was subsequently initiated, leading to early improvement in headache frequency and diplopia, independent of weight loss. Menstrual cycles, hormonal profile, and insulin resistance also improved beyond the effect of metformin alone. This case highlights the potential of exenatide to provide dual therapeutic benefits in IIH and PCOS, acting through direct receptor-mediated pathways to reduce ICP, improve headaches, and restore ovulatory cycles, and indirectly through the reduction of central obesity. Further studies are warranted to establish its role in the combined management of these conditions.