Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement

Abstract

Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.

Case Report: Glycogen Storage Disease Type Ia in a Chinese Child Treated With Growth Hormone

“…Growth retardation is one of the cardinal signs of GSD Ia, while there is no standard treatment due to unclear mechanism (1). Growth hormone has been used for over 35 years, and its safety and efficacy has been studied extensively in GDH, ISS, Turner syndrome, and intracranial and pituitary tumors (15). However, growth hormone in the treatment of severe growth retardation in children with GSD Ia is rarely reported.…”

The Challenging Management of Craniopharyngiomas in Adults: Time for a Reappraisal?

“…Hormonal deficiencies justify lifelong hormone replacement therapy (pituitary deficiencies including AVP deficiency). The question of growth hormone (GH) replacement therapy and the possible risk of recurrence must be discussed on a case-by-case basis, as emphasized by recent recommendations concerning intracranial tumors [ 27 ]. Although in vitro data suggests a proliferative effect of GH in cell culture [ 28 ], clinical data are actually very reassuring and GH substitution appears to be beneficial for patients with GH deficiency [ 29 , 30 , 31 ].…”

Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy

“…Diagnosis of GH deficiency may be challenging in patients treated for brain tumors due to alteration of the hypothalamus [ 75 , 76 ]. Differently to the general population, IGF1 and IGFBP3 do not seem to be reliable markers [ 75 ].…”