Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas: a case–control study

Abstract

Objective: Several studies documented metabolic and psychological benefits of GH substitution in deficient adults, most of them suffering from benign pituitary adenomas. Since GH substitution is considered to promote tumour regrowth, adequate treatment is performed with some reservation. Therefore, we aimed to elucidate the effect of GH replacement therapy on tumour recurrence following surgery. Methods: In patients with hormonally inactive pituitary adenomas undergoing tumour surgery, a retrospective case-control study was performed. Pre-and postoperative magnetic resonance (MR) images of GH-treated and untreated patients were matched for best fit by two independent observers. The treated patients were retrieved from the surveillance programme of the German KIMS database and the untreated from the database of the Department of Neurosurgery, University of Erlangen. A total of 55 matched pairs were followed for at least 5 years. Tumour recurrence and progression rates were determined according to the postoperative MR. Results: There were 16 tumour progressions in the treatment group and 12 in the control group. Statistical analysis revealed no significant increase in either recurrence (PZ0.317) or progression (PZ0.617) within the follow-up period of 5 years when GH was adequately replaced. Conclusions: This study provides further observational data of substitution therapy in GH-deficient adults with pituitary adenomas. Comparing long-term surgical results, we found no evidence that GH substitution should be withheld in deficient patients. Even residual tumour does not constitute a contraindication to GH replacement. However, since pituitary tumours are slow growing, an observational period of 5 years may not have been long enough to verify any absolute influence on recurrence potential. 157 149-156 European Journal of Endocrinology

Safety aspects of GH replacement

“…Out of the 55 matched pairs, there were 16 tumour progressions in the GH treatment group and 12 in the control group (69). Statistical analysis revealed no significant increase in either recurrence (PZ0.317) or progression (PZ0.617) within the follow-up period of 5 years (69). Therefore, in conclusion, available data do not suggest that GH replacement increases tumour recurrence or regrowth in adults, although further and larger studies are still needed.…”

“…This selection included eight cases of central nervous system or pituitary tumours, four during administration of placebo and four during administration of GH. In a later case-control study, the treatment group comprised patients from the German KIMS database, and the control group comprised patients who had never been exposed to GH therapy (69). Out of the 55 matched pairs, there were 16 tumour progressions in the GH treatment group and 12 in the control group (69).…”

“…In a later case-control study, the treatment group comprised patients from the German KIMS database, and the control group comprised patients who had never been exposed to GH therapy (69). Out of the 55 matched pairs, there were 16 tumour progressions in the GH treatment group and 12 in the control group (69). Statistical analysis revealed no significant increase in either recurrence (PZ0.317) or progression (PZ0.617) within the follow-up period of 5 years (69).…”

Growth hormone therapy and risk of recurrence/progression in intracranial tumors: a meta-analysis

“…Additional characteristics of the included studies are shown in Table 1. As shown in table, seven of the selected studies obtained seven or more scores, which indicated that the study quality was relatively higher [5][6][7][14][15][16][17][18][19][20][21][22]; whereas, other studies with relatively lesser scores were considered of lower quality [23][24][25].…”

“…Four studies [5,19,20,22] assessed the relationship between GHRT and risk of recurrence/progression in pituitary adenomas. The cumulative estimated risk associated with GH use was 0.85 (95 % CI 0.65-1.11; I 2 = 16.6 %, p for heterogeneity = 0.309).…”