Growth Hormone Deficiency in Young Cancer Survivors

Abstract

Growth hormone (GH) deficiency (GHD) is the most common late endocrine complication in childhood cancer survivors (CCS). We here review the etiologies, consequences, biological assessment, and treatment of GHD in adult CCS. In summary, screening of GHD should be proposed for every patient treated by cranial irradiation and surgery of the pituitary-hypothalamic area. Since chemotherapy and any brain tumor surgery may lead to GHD, this recommendation might be extended to every CCS. GHD contributes to the alteration of quality of life (QOL) and health status observed in CCS. GH therapy improves metabolic profile, bone mineralization, muscular performance, and QOL in adult GHD. Meta-analysis and pharmaceutical companies’ prospective databases of adult GH replacement are reassuring about the risk of second malignancies and recurrence. Reimbursement of GH therapy is currently restrained in most countries to patients with severe GHD (GH <3 ng/mL during an insulin tolerance test) associated with at least another pituitary deficiency. Initiation and follow-up of GH therapy by a specialist team in adult GHD and hypopituitarism is advised. Combined clinical, biological and safety monitoring is performed in the absence of a specific marker of responsiveness in adults as is the growth rate in children.