Background: Although colonic polyps are associated with states of GH excess, no association with gastric polyps has been reported. We describe 2 patients who were treated with rhGH for non-GH deficient growth disorders and who were subsequently found to have gastric polyps.
Patient 1: A girl aged 13.6 year with short stature was found to have Turners syndrome in the course of being investigated for abdominal pain, diarrhoea and rectal bleeding. Endoscopy and colonoscopy were initially normal. Her Ht SDS was −2.0 and IGF1SDS −0.3. RhGH was commenced at 0.3 mg/kg per week. After 1 year of treatment Ht velocity (HV) was 3.3 cm/year. 1.5 years later HV was 5 cm/year, rhGH dose was 0.22 mg/kg per week and IGF1 SDS −0.1. Endoscopy and colonoscopy were repeated due to ongoing GI symptoms and multiple hyperplastic polyps were found in the gastric fundus.
Patient 2: A prepubertal 11.3 year old girl with Prednisolone-dependent severe asthma, HtSDS −1.8, HV 0 cm/year, IGF1SDS −0.8, peak stimulated GH level 19.9 mU/l, was commenced on rhGH (0.26 mg/kg per week). Prior to treatment she had upper GI symptoms suggestive of gastro-oesophageal reflux. An endoscopy performed 1 year prior to starting rhGH showed mild oesophagitis. One year after commencing rhGH, HV improved to 2.5 cm/year and IGF1SDS rose to +1.3. GI symptoms continued to be troublesome despite medical therapy and after 2 years of rhGH (HV 3.3 cm/year, rhGH dose 0.23 mg/kg per week, IGF1SDS +0.7), repeat endoscopy revealed several hyperplastic polyps in the body of the stomach.
Discussion: These are the first reports of gastric polyps in association with rhGH therapy. Both children had GI symptoms prior to therapy and it is difficult to establish a causative link between the polyps and GH therapy, especially given that serum IGF-1 levels were not particularly high. However, it may be prudent to consider a thorough GI evaluation at baseline and subsequently in all children with GI symptoms who start GH therapy.