Endocrine Abstracts

Experimental studies have shown that GH and IGFs stimulate cell mutagenesis and proliferation. Moreover, an association between high-normal serum IGF-I levels and an increased risk of malignancies has been suggested in the general population. Bearing this relationship in mind, the question raises whether patients with GH deficiency (GHD) replaced with GH are at increased risk of developing malignancies and whether some patients, particularly cancer survivors, are more prone to develop secondary cancers.

Data accumulated over a period of 30 years in more than hundred thousand GHD children showed an overall satisfactory safety profile¹ as no increase in malignancies was observed. One exception were cancer survivors, in which an increased risk of secondary brain tumours after irradiation therapy was observed when compared to patients not replaced by GH².

Information on cancer development in GH-replaced adults has been collected in more than twenty thousand patients over a period of 20 years. National data are available for The Netherlands³, Sweden⁴ and from two larger observational studies, Pfizer’s KIMS⁵ and Lilly’s HypoCCS⁶. These analyses showed a comparable cancer type distribution as in the general population without an increased risk of malignancy. One study demonstrated an increased association between the development of a malignant brain tumour and irradiation therapy. A limitation of all these studies remains the short observation period to assess adequately the effect of GH replacement on cancer development, necessitating further long-term data collection.

References

1. Bell J et al. J Clin Endocrinol Metab 2010 95 167.

2. Sklar CA et al. J Clin Endocrinol Metab 2002 87 3136.

3. van Bunderen CC et al. J Clin Endocrinol Metab 2011 96 3151.

4. Burman P et al. J Clin Endocrinol Metab 2013 98 1466.

5. Gaillard RC et al. Eur J Endocrinol 2012 166 1069.

6. Child CJ et al. Eur J Endocrinol 2011 165 217.