Safety of GH replacement in hypopituitary patients with nonirradiated pituitary and peripituitary tumours

Summary Background  Published data suggest that growth hormone replacement (GHR) may be given safely to patients with hypopituitarism consequent upon a pituitary/peripituitary tumour. However, a preponderance of patients treated with external pituitary irradiation were included. Objective  To assess the safety of GHR in nonirradiated pituitary/peripituitary tumour. Design  Prospective audit. Setting  Tertiary university referral centre. Patients  We imaged prospectively the pituitary glands of 48 patients (18 males; mean age 51·6 years range 21–77) who had adult onset growth hormone deficiency (AO-GHD) after appropriate treatment for a pituitary/peripituitary tumour but who did not receive external pituitary irradiation. Intervention  All patients were treated with a dose titration regimen of GH to maintain serum IGF-1 between the median and upper end of the age-related reference range. Pituitary surveillance imaging was performed prior to the commencement of GHR, at 6–12 months and then yearly. For patients with secretory tumours, biochemical markers (cortisol and prolactin) were used as evidence of tumour recurrence. Results  48 patients with median follow up since commencement of GHR was 38 months (range 9–104). Three patients were judged to have an apparent increase in tumour volume and/or marker, although only one was thought to be possibly GH related – a patient with a cystic chromophobe adenoma who demonstrated a marginal increase in residual tumour volume 4 years after commencement of GHR. Conclusion  These data add to the growing body of evidence for the safety of GHR in hypopituitary patients consequent upon pituitary/peripituitary mass lesions and represents the first reported series in a heterogeneous group of nonirradiated patients.