Expert Opinion on the Management of Growth Hormone Deficiency in Brain Tumor Survivors: Results From an Italian Survey

Abstract

BackgroundGrowth hormone deficiency (GHD) is the first and most common endocrine complication in pediatric brain tumor survivors (BTS). GHD can occur due to the presence of the tumor itself, surgery, or cranial radiotherapy (CRT).AimsThis study aimed to evaluate management and adherence to current guidelines of the Italian centers engaged in the diagnosis and follow-up of GHD patients with BTS.MethodsA multidisciplinary scientific board of pediatric endocrinologists, oncologists and radiologists with neuroimaging expertise discussed and reviewed the main issues relating to the management of GHD in pediatric BTS and developed a survey. The survey included questions relating to organizational aspects, risk factors, diagnosis, definition of stable disease, and treatment. The online survey was sent to an expanded panel of specialists dedicated to the care of pediatric BTS, distributed among the three specialty areas and throughout the country (23 Italian cities and 37 Centers).ResultsThe online questionnaire was completed by 86.5% (32 out of 37) of the Centers involved. Most had experience in treating these patients, reporting that they follow more than 50 BTS patients per year. Responses were analyzed descriptively and aggregated by physician specialty. Overall, the results of the survey showed some important controversies in real life adherence to the current guidelines, with discrepancies between endocrinologists and oncologists in the definition of risk factors, diagnostic work-up, decision-making processes and safety. Furthermore, there was no agreement on the neuroimaging definition of stable oncological disease and how to manage growth hormone therapy in patients with residual tumor and GHD.ConclusionsThe results of the first Italian national survey on the management of GHD in BTS highlighted the difference in management on some important issues. The time to start and stop rhGH treatment represent areas of major uncertainty. The definition of stable disease remains critical and represents a gap in knowledge that must be addressed within the international guidelines in order to increase height and to improve metabolic and quality of life outcomes in cancer survivors with GHD.

Regulation of ovarian function by growth hormone: Potential intervention of ovarian aging

“…GH can lead to significant metabolic changes by increasing cholesterol and interfering with renin angiotensin ( 38 ). Although there is no definite evidence about carcinogenesis of GH in therapeutic dose, the safety of long-term drug use in patients with malignant tumor, aggravating metabolic disorder, and other unforeseen adverse events should be continuously monitored ( 39 , 40 ). It has not been found that the application of GH in IVF treatment will cause adverse effects on hysteromyoma, endometriosis, adenomyosis, adverse pregnancy outcomes, etc., but long-term follow-up and observation are still needed.…”

Evaluation of Metabolic and Cardiovascular Risk Measured by Laboratory Biomarkers and Cardiopulmonary Exercise Test in Children and Adolescents Recovered from Brain Tumors: The CARMEP Study

“…During the last few decades, the pediatric brain cancer survival rate increased due to the improvement in therapeutic regimens, which involve the combination of chemotherapy, radiotherapy, and supportive therapies (e.g., high dosage steroids, antibiotics, and growth factors) [1,2]. These treatments, although they facilitate recovery from cancer, have longterm toxic effects on organs and systems like the kidneys, heart, hearing, and endocrine system [3][4][5][6][7][8]. Furthermore, they also cause the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increase cardiovascular risk [9].…”