Relapse of intracranial germinoma 23 years postirradiation in a patient given growth hormone replacement

Tumour surveillance imaging in patients with extrapituitary tumours receiving growth hormone replacement

“…Although this would suggest that he may have been at higher risk of recurrence, it should be noted that he is the only patient of the five in the Janmohamed series 8 subsequently treated with GH to have relapsed. GH has been associated with disease relapse 23 years after initial treatment of a germ cell tumour, although in that case, unlike here, no imaging was performed prior to commencement of GH 10 . No obvious increased recurrence over background was reported from a large multinational outcomes‐based database, although radiological surveillance in that series is likely to have been heterogeneous 11 .…”

“…GH has been associated with disease relapse 23 years after initial treatment of a germ cell tumour, although in that case, unlike here, no imaging was performed prior to commencement of GH. 10 No obvious increased recurrence over background was reported from a large multinational outcomes-based database, although radiological surveillance in that series is likely to have been heterogeneous. 11 Vigilant monitoring is clearly mandatory in patients with treated germ cell tumours who commence GH for symptomatic GHD.…”

“…Our current practice is for baseline imaging prior to commencement of GH, a follow‐up scan at 1 year, with subsequent scans determined by the physician's perception of the risk of recurrence. The anecdotal experience here and elsewhere 10 suggests that patients with treated germ cell tumours require particularly vigilant surveillance. Although we do not consider GH to be contraindicated in hypopituitary patients with treated germ cell tumours, our current practice is for annual surveilllance imaging.…”

Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas: a case–control study

“…However, epidemiological studies that suggest a correlation between the mean IGF-I level and the risk of developing malignant tumours have alerted both the public and the medical experts (7,8,12). Furthermore, individual anecdotal reports related the relapse of an intracranial tumour to GH treatment (4,13). In contrast to acromegaly, where IGF-I levels are unequivocally elevated and the rate of colonic neoplasms is increased, in GH-deficient patients, the substitution therapy aims at augmentation of hormone levels and normalization of IGF-I.…”

Suprasellar germ cell tumours: specific problems and the evolution of optimal management with a combined chemoradiotherapy regimen

“…Although replacement therapy for growth hormone deficiency due to pituitary and non-GCT suprasellar tumours and / or their treatment is now established, the safety of doing so in the context of intracranial GCT in remission is open to debate. Even though GH replacement has been associated with relapse of GCT in a single patient (Kiltie et al, 1997), there is no consensus on this matter. We have commenced GH in one of our patients because of severe GH deficiency symptoms and signs of fatigue and osteopenia; he remains under rigorous surveillance.…”