ESPE Abstracts

Cancer treatment may result in development of long-term endocrine complications, including growth hormone (GH) deficiency^.1 Although extensive and careful monitoring has been carried out to establish the safety profile of GH therapy,² a relative scarcity of data means that questions persist around its use in survivors of childhood cancer. The effects of GH on growth and metabolism mean that there is a particular interest in whether GH therapy increases the risk of tumor recurrence or a second neoplasm in childhood cancer survivors.³ Expert assessment of the available evidence indicates that there is little to indicate that GH treatment causes a new primary cancer or recurrence of previous primary cancer in children; however, there is less evidence in the adult population of childhood cancer survivors, and treatment decisions need to be made on a case-by-case basis.³ Evidence for an increased risk of secondary or subsequent neoplasms in children who survived cancer is also scarce, but indicates a reduction in risk as the time after onset of GH treatment increases.³ The cellular effects of GH have also given rise to the suggestion that GH therapy can increase the risk of development of diabetes, although surveillance and clinical data indicate that this is limited to type 2 diabetes in predisposed individuals.⁴ This presentation will review the current best approach to management of growth hormone deficiency in childhood cancer survivors given the available data and discuss the considerations that must be made at initiation of GH therapy, and as it proceeds.

References

1. Robison LL and Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer 2014;14: 61–70

2. Stochholm K and Kiess W. Long-term safety of growth hormone-A combined registry analysis. Clin Endocrinol (Oxf) 2018; 88:515–28

3. Allen DB et al. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults. Eur J Endocrinol 2016;174:P1-9

Cutfield W et al. Incidence of diabetes mellitus and impaired glucose tolerance in children and adolescents receiving growth-hormone treatment. Lancet 2000; 355:610–3