GH replacement (GHR) has resulted in a significant improvement in quality of life for many adults with GH deficiency. Many of these patients are previously irradiated survivors of malignancy, and as such are at high risk of recurrent (RN) or secondary neoplasms (SN). There is a particularly strong association between CNS irradiation and subsequent development of meningiomas, which are known to express GH receptors. There is uncertainty as to whether GHR increases the risk of development of RN or SN. We present our experience from a single centre demonstrating the incidence of tumour recurrence in a large cohort of patients undergoing GH replacement.
An electronic database was used to identify 358 adult patients who had been on GHR for at least 12 months over the period 19942009. Two hundred and sixty-three (73.5%) of patients had a history of cranial irradiation. Data was gathered from case records and the electronic database. Regular surveillance MR or CT brain imaging was carried out. RN were identified in 10 (2.8%) of patients, resulting in death in seven patients. SN were seen in 19 (5.3%) of patients, 17 of which were meningiomas. No SN resulted in death. A history of cranial irradiation was present in 29 (96.7%) of patients with RN/SN. Of the 95 non-irradiated patients, SN was seen in only one patient (1.1%).
Our experience extends a previous report focussing primarily on childhood onset GH deficiency. Interestingly, all SN under GHR were found in previously irradiated patients with 17/19 being meningiomas. The incidence of RN/SN is comparable to that previously demonstrated in large series of cancer survivors not treated with GH. It can be speculated that any effect of GHR on tumour recurrence is likely to be small, although controlled studies would be required to confirm this.