The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke

Sina Jasim, Fares Alahdab, Ahmed T. Ahmed, Shrikant U. Tamhane, Anu Sharma, Diane Donegan, Todd B. Nippoldt, Mohammad H Murad

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Growth hormone replacement therapy has benefits for patients with hypopituitarism. The safety profile in regard to tumor recurrence or progression, development of secondary malignancies, or cerebrovascular stroke is still an area of debate. A comprehensive search of multiple databases—MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted through August 2015. Eligible studies that evaluated long-term adverse events in adult patients with hypopituitarism treated with growth hormone replacement therapy and reported development of pituitary tumor recurrence or progression, secondary malignancies, or cerebrovascular stroke were selected following a predefined protocol. Reviewers, independently and in duplicate, extracted data and assessed the risk of bias. Random-effects meta-analysis was used to pool relative risks and 95 % confidence intervals. We included 15 studies (published 1995–2015) that reported on 46,148 patients. Compared to non-replacement, growth hormone replacement therapy in adults with hypopituitarism was not associated with statistically significant change in pituitary tumor progression or recurrence (relative risk, 0.77; 95 % confidence interval, 0.53–1.13) or development of secondary malignancy (relative risk, 0.99; 95 % confidence interval, 0.70–1.39). In two retrospective studies, there was higher risk of stroke in patients who did not receive replacement (relative risk, 2.07; 95 % confidence interval, 1.51–2.83). The quality of evidence is low due to study limitations and imprecision. This systematic review and meta-analysis supports the overall safety of growth hormone therapeutic use in adults with hypopituitarism with no clear evidence of increased risk of pituitary tumor recurrence, malignancy, or stroke.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalEndocrine
DOIs
StateAccepted/In press - Nov 4 2016

Fingerprint

Hypopituitarism
Pituitary Neoplasms
Growth Hormone
Stroke
Recurrence
Hormone Replacement Therapy
Neoplasms
Confidence Intervals
Meta-Analysis
Safety
Therapeutic Uses
Retrospective Studies
Databases

Keywords

  • Cancer
  • Growth hormone
  • Hypopituitarism
  • Recurrence
  • Stroke

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke. / Jasim, Sina; Alahdab, Fares; Ahmed, Ahmed T.; Tamhane, Shrikant U.; Sharma, Anu; Donegan, Diane; Nippoldt, Todd B.; Murad, Mohammad H.

In: Endocrine, 04.11.2016, p. 1-12.

Research output: Contribution to journalArticle

Jasim, Sina ; Alahdab, Fares ; Ahmed, Ahmed T. ; Tamhane, Shrikant U. ; Sharma, Anu ; Donegan, Diane ; Nippoldt, Todd B. ; Murad, Mohammad H. / The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke. In: Endocrine. 2016 ; pp. 1-12.
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