Tuesday, September 8, 2009

Comparing progression of non-functioning pituitary adenomas in hypopituitarism patients with and without long-term growth hormone replacement therapy

Daniel Olsson, Michael Buchfelder, Sven Schlaffer, Bengt-Åke Bengtsson, Karl-Erik Jakobsson, Gudmundur Johannsson and Anna Nilsson

D Olsson, Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
M Buchfelder, Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
S Schlaffer, Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
B Bengtsson, Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
K Jakobsson, Neurosurgery, Sahlgrenska University Hospital, Göteborg, Sweden
G Johannsson, Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
A Nilsson, Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden

Correspondence: Daniel Olsson, Email: daniel.s.olsson@telia.com

Objective: An important safety issue with growth hormone replacement therapy (GHRT) in hypopituitary patients with a history of a pituitary adenoma is the risk for tumour recurrence or enlargement.

Design: Case-control study.

Subjects and Methods: We studied tumour progression rate in 121 patients with hypopituitarism on the basis of non-functional pituitary adenomas (NFPA) receiving long-term GHRT. A group of 114 NFPA patients not receiving GHRT who were matched in terms of duration of follow-up, gender, age, age at diagnosis and radiotherapy status were used as a control population. The average duration of GHRT was 10 ± 4 years (range 2-17).

Results: In patients with a known residual adenoma, 63 % had no detectable enlargement of tumour during the study. In patients who had no visible residual tumour prior to GHRT, 90 % did not suffer from recurrence. In total, the 10-year tumour progression free survival rate in patients with NFPA receiving GHRT was 74 %. In the control population not receiving GHRT the 10-year progression free survival rate was 70 %. Radiotherapy as part of the initial tumour treatment reduced the rate of tumour progression in both GHRT and non-GHRT patients to a similar extent.

Conclusions: The rate of tumour progression was similar in this large group of GHRT patients and the control population not receiving GHRT. Our results provide further support that long-term use of GH replacement in hypopituitarism may be considered safe in patients with residual pituitary adenomas.

from http://www.eje.org/cgi/content/abstract/EJE-09-0572v1