PNA Medical Corner: GHRT

Dr. Aart Jan van der LelyThis month the PNA Medical Corner focuses on an article co-authored by Dr. Aart Jan van der Lely, who sits on the PNA Scientific Advisory Board. It is called Tumor recurrence or regrowth in adults with nonfunctioning pituitary adenomas using GH replacement therapy – a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults and was published recently in the Journal of Clinical Endocrinology and Metabolism. The authors concluded that growth hormone replacement therapy does not increase the risk of tumor recurrence and should be considered safe.
N.C. van Varsseveld1, C.C. van Bunderen1, A.A.M. Franken2, H.P.F. Koppeschaar3, A.J. van der Lely3, and M.L. Drent1

 

Abstract

Context:

GH replacement therapy (GH-RT) is a widely accepted treatment in GH deficient (GHD) adults with nonfunctioning pituitary adenoma (NFPAs). However, some concerns have been raised about the safety of GH-RT, because of its potentially stimulating effect on tumor growth.

Objective:

The aim of this study was to evaluate tumor progression in NFPA patients using GH-RT.

Design, Setting and Patients:

From the Dutch National Registry of Growth Hormone Treatment in Adults, a nationwide surveillance study in severe GHD adults (1998–2009), all NFPA patients with ≥ 30 days of GH-RT were selected (n=783). Data were retrospectively collected from the start of GH-RT in adulthood (baseline).

Main Outcome Measure:

Tumor progression, including tumor recurrence after complete remission at baseline and regrowth of residual tumor.

Results:

Tumor progression developed in 12.1% of the patients after a median time of 2.2 (0.1–14.9) years. Prior radiotherapy decreased tumor progression risk compared to no radiotherapy (Hazard ratio [HR] = 0.16, 95% confidence interval [CI] = 0.09–0.26). Analysis in 577 patients with available baseline imaging data showed that residual tumor at baseline increased tumor progression risk compared to no residual tumor (HR = 4.5, 95% CI 2.4–8.2).

Conclusions:

The findings in this large study were in line with those reported in literature and provide further evidence that GH-RT does not appear to increase tumor progression risk in NFPA patients. Although only long-term randomized controlled trials will be able to draw firm conclusions, our data support the current view that GH-RT is safe in NFPA patients.

Affiliations

1Department of Internal Medicine, Endocrine section, Neuroscience Campus Amsterdam, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
2Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
3Emotional Brain and Alan Turing Institute for multidisciplinary health research, Almere, the Netherlands
4Division of Endocrinology and Metabolism, department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands http://press.endocrine.org/doi/abs/10.1210/jc.2015-1764

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