Endocrine Abstracts

Does GH replacement increase the risk of recurrence in patients with craniopharyngioma?

N Karavitaki¹, JT Warner², B Shine¹, IM Stratton¹, HE Turner¹ & JAH Wass¹

¹Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; ²Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.

Background: The safety of GH replacement in patients with craniopharyngioma has not been clearly elucidated.

Aim: To assess whether GH replacement increases the risk of craniopharyngioma recurrence.

Patients and Methods: The records of the patients with craniopharyngioma followed-up at the Departments of Endocrinology and Paediatrics between 1/1964-6/2004 were reviewed. The recurrence risks of GH-treated and non-GH-treated patients were compared. Cox regression analysis adjusting for type of tumour treatment (with GH therapy as time-dependent variable) was used.

Results: Thirty-six GH-treated patients were identified. Seven had insufficient imaging data. The remaining 29 were finally evaluated [20 males, mean age at tumour diagnosis 16.0±13.8 (1-51)] (Group A). Fifty-seven subjects [31 males, mean age at tumour diagnosis 37.9±17.2 (8-68)] were used as controls (Group B). The standard dosage in children was 12-20 IU/m2/week. The adults received a dose titration regime to maintain IGF-I within normal limits (0.3-2 IU/day). The median duration of GH treatment was 48 months (8-264) and of follow-up 64 (8-324) and 47 months (5-432) in Groups A and B, respectively. 19 subjects started GH during childhood (5 continued after achievement of final height with adult dose) and 10 during adult life.

The overall recurrence rate was 13.8% over 174 patient-years at risk (Group A) and 36.8% over 449 patient-years at risk (Group B). Patients treated with gross total removal had no recurrence in either group. In Group A the overall recurrence rate was 33.3% over 31 patient-years at risk after partial removal and 10.5% over 100 patient-years at risk after surgery+radiotherapy. After adjusting for type of tumour treatment the relative risk of recurrence was not different between Groups A and B.

Conclusion: In this long-term follow-up study using appropriate controls we showed that GH replacement in patients with craniopharyngioma is not associated with increased risk of tumour recurrence.

Endocrine Abstracts (2005) 9 OC25