Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy

Varsseveld, N. C. van; Bunderen, Christa C. van; Franken, Anton; Koppeschaar, H. P. F.; Lely, Aart Jan van der; Drent, Madeleine L.

doi:10.1210/jc.2015-1764

Cited by 20 publications

(8 citation statements)

References 41 publications

(61 reference statements)

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“…In vitro and animal experiments suggest that it can raise the risk for hyperplasia and malignancy [ 21 – 25 ]. To the best of our knowledge, no such study is available in the context of hypothalamic hamartoma in humans, but we did find some similarity with studies concerning non-functioning pituitary adenomas (NFPA), a more common tumor, benign in nature with very long stability [ 26 – 30 ]. These studies provide evidence that GH treatment does not appear to increase tumor progression [ 26 – 30 ].…”

Section: Discussionsupporting

confidence: 54%

“…To the best of our knowledge, no such study is available in the context of hypothalamic hamartoma in humans, but we did find some similarity with studies concerning non-functioning pituitary adenomas (NFPA), a more common tumor, benign in nature with very long stability [ 26 – 30 ]. These studies provide evidence that GH treatment does not appear to increase tumor progression [ 26 – 30 ]. In fact, while on treatment, we did follow our patient with repeated MRI once per year and there was no change in tumor size and no tumor progression.…”

Section: Discussionsupporting

confidence: 54%

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Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report

Hayek

2018

J Med Case Reports

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BackgroundPallister–Hall syndrome is a rare, autosomal dominant, genetic disorder characterized by different congenital abnormalities: hypothalamic hamartoblastoma, bifid or shortened epiglottis, polydactyly, renal anomalies, and imperforate anus.Case presentationIn this case report, we describe the case of a 13-year-old Lebanese-Armenian boy born with Pallister–Hall syndrome showing newly associated manifestations (orofacial narrowing and tethered cord), and currently showing a spontaneous puberty with normal growth pattern following management with growth hormones.ConclusionsThis case report shows a practical approach to this very rare syndrome, mainly with testosterone and growth hormones, and its follow-up in the long term. Being familiar with such cases may allow improvement of our knowledge for better management in the future.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionsupporting

confidence: 54%

Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report

Hayek

2018

J Med Case Reports

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“…Since we found no patients with functional microadenomas, we cannot draw any conclusions about the effect of GH therapy in that setting. Our findings in pediatric patients are in contrast to those in adults, who more commonly have GHD associated with nonfunctioning pituitary adenomas [7] and may experience regrowth of the tumor after receiving GH therapy [15]. Importantly, these studies rarely analyze the subgroup of microadenomas, so a direct comparison with our population cannot be made.…”

Section: Discussionmentioning

confidence: 68%

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

2018

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Background/Aims: Patients with short stature (SS)/growth hormone deficiency (GHD) and precocious puberty (PP) undergo brain MRI to evaluate for structural brain abnormalities or pituitary lesions, and pituitary microadenomas are a common finding. Theoretically, a mass effect from these lesions could cause GHD and growth hormone treatment could cause them to enlarge, but they should not cause PP, at least in females. Methods: We investigated if pituitary microadenomas cause GHD by comparing their incidence in patients with SS/GHD to that in females with PP. We performed a retrospective chart review of patients with these disorders who had a brain MRI between 2000 and 2013. Results: The incidence of microadenoma was high in both groups, 18.5% for SS (n = 346) and 21.1% for PP females (n = 194), but did not differ between groups (p = 0.46). In patients with microadenomas, repeat imaging showed resolution in 58% (SS, n = 33) and 67% (PP females, n = 21). Importantly, none of the lesions grew, even in patients treated with growth hormone. Conclusions: Pituitary microadenomas are common in children with GHD/SS and PP, but it does not appear that they are a cause of GHD. They appear to be of limited clinical significance and should not be considered a contraindication to growth hormone therapy.

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“…GH replacement AEs at the recommended doses (fluid retention, arthralgias, myalgias, paresthesias, carpal tunnel syndrome, sleep apnoea, sleep disturbances, dyspnoea) are reported in approximately 20% of patients but remit on lowering the GH dose. However, high doses of replacement may result to insulin resistance and/or new-onset diabetes [53]. Other suggested complication includes the development of new primary cancers but long-term studies did not confirm an increased prevalence or recurrence of the primary tumour after GH replacement therapy, and the occurrence of new tumours, if it occurs, appears to be very rare [53][54][55].…”

Section: Growth Hormone (Gh) Deficiency Replacement Treatmentmentioning

confidence: 99%

Management of Hypopituitarism

Alexandraki

Grossman

2019

JCM

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Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland’s ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2–3 divided doses. However, novel once-daily modified-release HC targets a more physiological exposure of glucocorticoids. GHD is treated currently with daily subcutaneous GH, but current research is focusing on the development of once-weekly administration of recombinant GH. Hypogonadism is targeted with testosterone replacement in men and on estrogen replacement therapy in women; when fertility is wanted, replacement targets secondary or tertiary levels of hormonal settings. Thyroid-stimulating hormone replacement therapy follows the rules of primary thyroid gland failure with L-thyroxine replacement. Central diabetes insipidus is nowadays replaced by desmopressin. Certain clinical scenarios may have to be promptly managed to avoid short-term or long-term sequelae such as pregnancy in patients with hypopituitarism, pituitary apoplexy, adrenal crisis, and pituitary metastases.

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Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy

Cited by 20 publications

References 41 publications

Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report

Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

Management of Hypopituitarism

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