Longitudinal changes in nonfunctioning pituitary neuroendocrine tumors in children receiving growth hormone therapy: A comparison with untreated patients.
RhGH therapy did not show significant progression of nonfunctional PitNETs over 36 months in this small cohort of children.
Where it sits
this study against the rest of the hgh (somatropin) corpusSummary and findings
This study evaluated longitudinal changes in tumor size of nonfunctional pituitary neuroendocrine tumors (PitNETs) in 15 growth hormone deficiency (GHD) patients receiving recombinant human growth hormone (rhGH) therapy compared to 30 untreated controls. No significant changes in tumor dimensions were observed over 36 months. One patient in the rhGH group underwent PitNET excision.
Abstract
Background: Growth hormone deficiency (GHD) may result from structural abnormalities or space-occupying lesions of the pituitary gland; therefore, pituitary magnetic resonance imaging (MRI) is routinely performed as part of the etiological assessment. The reported prevalence of incidentally detected pituitary neuroendocrine tumors (PitNETs) in pediatric patients with GHD ranges from 0.5% to 20.3% across studies. PitNETs are rare in childhood and account for approximately 2.7% of supratentorial pediatric tumors and 3.6-6% of surgically treated PitNETs. Insulin-like growth factor-1 (IGF-I), a mitogenic agent elevated during recombinant human growth hormone (rhGH) therapy, has raised theoretical concerns regarding tumor growth stimulation. Objective: To evaluate longitudinal changes in tumor size of nonfunctional PiNETs, in patients with pre-existing PitNETs receiving rhGH therapy compared with untreated controls. Methods: This single-center retrospective cohort study included 15 GHD patients with PitNETs detected before rhGH initiation and 30 control patients with nonfunctional incidental PitNETs who did not receive rhGH therapy. Radiological follow-up was performed at baseline and at 6, 12, 18, 24, and 36 months. Results: No significant longitudinal changes in PitNETs width or length were observed in either group. One rhGH-treated patient underwent PitNET excision. Indications for pituitary imaging in the control group were predominantly central precocious puberty, headache, central hypothyroidism, and short stature. Conclusion: RhGH therapy was not associated with significant progression of nonfunctional PitNETs during a 36-month follow-up, supporting its safety when accompanied by regular radiological surveillance.
Background
This paper addresses the potential impact of recombinant human growth hormone (rhGH) therapy on the growth of nonfunctional pituitary neuroendocrine tumors (PitNETs) in children with growth hormone deficiency (GHD). Prior studies have indicated a prevalence of incidentally detected PitNETs in pediatric GHD patients ranging from 0.5% to 20.3%. The theoretical concern regarding rhGH therapy stems from its elevation of insulin-like growth factor-1 (IGF-I), which may stimulate tumor growth. This study aims to clarify whether rhGH therapy is associated with tumor progression in this population.
Methods
This is a single-center retrospective cohort study involving 15 GHD patients with pre-existing PitNETs who received rhGH therapy and 30 control patients with nonfunctional incidental PitNETs who did not receive rhGH. Radiological follow-up was conducted at baseline and at 6, 12, 18, 24, and 36 months. The primary outcome measure was the change in tumor size over time.
Results
No significant longitudinal changes in PitNETs width or length were observed in either group over the 36-month follow-up period. One patient in the rhGH group underwent PitNET excision, but specific data regarding the excised tumor's characteristics were not provided.
Interpretation
The findings suggest that rhGH therapy does not significantly affect the progression of nonfunctional PitNETs in children over a 36-month period, which may provide some reassurance regarding the safety of rhGH therapy in this context. However, the small sample size and retrospective nature of the study limit the ability to draw strong conclusions. Further research with larger cohorts and longer follow-up is needed to confirm these results.
Key findings
- No significant longitudinal changes in PitNETs width or length were observed in either group.
- One rhGH-treated patient underwent PitNET excision.
- Indications for pituitary imaging in the control group included central precocious puberty, headache, central hypothyroidism, and short stature.
Limitations
- small sample size of n=45
- retrospective design limits causal inference
- single-center study may affect generalizability
- no detailed data on excised tumor characteristics