Is Growth Hormone Therapy Safe with Residual Pituitary Tumor?


Question

I have a 60 year old patient who is post transsphenoidal resection of a large macroadenoma. He has growth hormone deficiency and hypogonadism and I am weaning him off of steroids. He is much better symptomatically on growth hormone, but a post-op MRI reveals

some residual tumor. Is growth hormone contraindicated here because of the residual tumor? Thank you very much. Ann Ward>

Response

This is an interesting question. There are two parts to this: firstly, the value of replacing GH in an older age group, and secondly, its safety when there is residual tumour. The answer to both is positive. There is published evidence that GH replacement should be considered regardless of age, although of course the normal range in which one would like to get circulating IGF-1 falls with age; we try and place the IGF-1 in the normal age- and sex-adjusted range but above the median. In terms of safety, there have now been numerous reports which can reference if you are interested in which GH has been shown not to be a risk factor for tumour regrowth or recurrence. However, you should bear in mind that when there is residual tumour postoperativey, the 10-year recurrence rate is pretty high in the absence of external beam radiotherapy regardless as to wh e ther GH is admi n istered. Regards, Ashley Grossman, MD