Hyperinsulinemia may promote growth without GH in children after resection of suprasellar brain tumors

Abstract

It remains elusive what factors induce growth without growth hormone (GWGH) in children after neurosurgery of brain tumors. Growth velocity and endocrinological data were compared between the patients with and without GWGH. We experienced three patients with GWGH (median, 12 years; 2 germinoma and 1 craniopharyngioma; three females; group 1) and 11 patients without (12 years; 8 craniopharyngioma, 2 germinoma and 1 medulloblastoma; 7 males; group 2) after neurosurgery. All patients in group 2 received GH replacement therapy. Growth velocity and endocrinological data were compared. Median height velocity was normal in group 1 (5.5 cm/year), but low in group 2 (2.2 cm/year), which improved after GH replacement therapy (7.0 cm/year). Median serum insulin level was increased in group 1 (87.0 μU/ml, P < 0.05) compared with normal level in group 2 (10.0 μU/ml). Despite hyperinsulinemia, serum glucose level was normal in group 1. Three of 5 with hyperinsulinemia and 2 of 9 without were obese or overweight, but the difference was not significant. Current body mass index and serum levels of IGF-1, IGFBP-3, leptin, and prolactin were similar between groups. Serum estradiol was prepuberty level in group 1. Hyperinsulinemia may induce GWGH in children with brain tumors after neurosurgery.

Early traits of metabolic syndrome in pediatric post-cancer survivors: outcomes in adolescents and young adults treated for childhood medulloblastoma

“…However, to date, these variations are within normal values. Hyperinsulinemia and an adverse lipid profile have been described as an effect of therapy in patients treated for various types of cancer with adjuvant RT, and after BMT (6,(8)(9)(10)(11)39). In addition, GH status was associated with insulin sensitivity in this sample.…”

Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors

“…This association could be due to the fact that obese subjects with MS had significantly higher levels of insulin resistance, since pubertal increase in insulin resistance and compensatory hyperinsulinemia facilitate protein anabolism during the period of pubertal growth, and growth hormone and IGF-1 levels are closely associated with pubertal changes in insulin resistance (32,33). Hyperinsulinemia is also associated with growth without growth hormone in children after neurosurgery (34). Furthermore, recent data indicate that, independent of BMI, height and growth velocity significantly correlate with insulin resistance in children (35).…”

Predicting the Probability of Abnormal Stimulated Growth Hormone Response in Children After Radiotherapy for Brain Tumors

“…We speculate that the decline in stimulated growth hormone response may occur before the manifestation of growth failure. The confounding factor of obesity may contribute to the disassociation (20). However, our finding should not be misinterpreted to discourage the use of growth velocity as one of the clinical criteria to initiate immediate investigation for GHD, particularly when low growth velocity is sustained over 1 to 2 years (19).…”