Abstract
Growth hormone (GH) deficiency is a common pituitary hormone deficiency in childhood cancer survivors (CCS). The identification, diagnosis, and treatment of those individuals at risk are important in order to minimize associated morbidities that can be ameliorated by treatment with recombinant human GH therapy. However, GH and insulin-like growth factor-I have been implicated in tumorigenesis, so there has been concern over the use of GH therapy in patients with a history of malignancy. Reassuringly, GH therapy has not been shown to increase risk of tumor recurrence. These patients have an increased risk for development of meningiomas, but this may be related to their history of cranial irradiation rather than to GH therapy. In this review, we detail the CCS who are at risk for GHD and the existing evidence on the safety profile of GH therapy in this patient population.
Highlights
Growth hormone deficiency (GHD) is the earliest reported and most common pituitary hormone deficiency in central nervous system childhood cancer survivors (CCS), with an overall prevalence of 12.5% [1]
Patients who receive craniospinal radiation are at even greater risk for short stature than those receiving cranial radiation alone due to direct damage of the spinal radiation on bone matrix, with the greatest deficit occurring in those irradiated at younger age [4]
The aim of this review is to describe the sub-population of CCS at greatest risk for development of GHD and to highlight the most recent literature on the safety profile of growth hormone (GH) therapy with respect to tumor recurrence and secondary malignancies in childhood cancer survivors
Summary
Growth hormone deficiency (GHD) is the earliest reported and most common pituitary hormone deficiency in central nervous system childhood cancer survivors (CCS), with an overall prevalence of 12.5% [1] This is a consequence of the location of the brain tumor itself, as well as treatment modality, including neurosurgery, cranial radiation, and chemotherapy agents. A recent meta-analysis by Bolfi et al, demonstrated that upon control of disease (defined by normalization of IGF-1 level with varying cut-offs based on the study), the cause of death becomes similar to the general population, This analysis showed that the increased cancer incidence was for cancers not typically related to acromegaly, but instead those associated with environmental and genetic factors, as well as aging [31]. Age, length of follow-up and diagnostic thresholds; incidence may be lower if proton RT used 87% at 2.5 years with GHD 33% at 2.5 years with GHD Commonly GHD on presentation due to tumor location Universal GHD within 5 years Almost all within 2-3 years
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