GH replacement therapy in patients with primary paediatric brain tumours
E. Seregni, F. Pallotti, V. Biassoni, S. Catania, L. Gandola, F. Spreafico, M. Terenziani, A. Mallia, E. Bombardieri & M. Massimino
Aim: Endocrinopathies are frequent complications in paediatric patients with primary brain tumours (PBT) and among them GH deficiency (GHD) is of particular relevance. In this study we evaluated the incidence of GHD and the impact of GH therapy in a large series of PBT bearing patients or adult patients previously treated for PBT.
Methods: From January 2001 to December 2011 more than 700 PBT patients were screened for endocrine complications. GHD was explored by provocative tests (arginine and clonidine) in a subgroup of patients on the basis of laboratory (IGF1 levels), auxological (growth failure, low height velocity, delayed skeletal maturation) and clinical findings (anti-neoplastic therapies adopted life expectancy). Patients with proven GHD were treated with recombinant GH at initial dosage of 0.22 mg/kg per week for children and 0.3 mg/die for adults. For each patient the GH dose was tailored on the basis of circulating IGF1.
Results: 110 PBT patients displayed GHD. Of these patients, 47 had diagnosis of medulloblastoma, 21 germ-cell tumours, eight low-grade gliomas, eight ependymoma, five supratentorial PNET and 21 other histological PBT. They received chemotherapy (conventional and/or high-dose chemotherapy) and/or radiotherapy according to our institutional protocols and to the clinical course. In all but five children (with precocious puberty and cranio-spinal irradiation) growth recovery was observed. Improvement of bone mineral density was attained either in children or in adults. A particularly interesting observation was the improvement in the neuropsychological performances of several patients secondary to GH therapy. A temporary discontinuation of GH therapy was necessary in three patients due to worsening of cerebral radionecrosis. Disease recurrence was found in seven and this relapse rate is lower than in non-GH treated patients.
Conclusions: In our experience GH replacement therapy is safe and effective in the correction of GH deficiency and in improving quality of life of PBT patients.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.