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Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy

G Rodari1,2, A Cattoni3,4, A Albanese3

  • 1Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK. rodarigiulia@gmail.com.

Journal of Endocrinological Investigation
|August 28, 2019
PubMed

Insights

Recombinant human growth hormone (rhGH) therapy in childhood cancer survivors with growth hormone deficiency (GHD) did not achieve predicted final height but prevented further height loss. Outcomes were significantly poorer in those receiving craniospinal or total body irradiation.

Area of Science:

  • Pediatric Endocrinology
  • Oncology
  • Growth Hormone Therapy

Background:

  • Growth hormone deficiency (GHD) is a common hypothalamic-pituitary disorder in childhood cancer survivors (CCS).
  • Previous studies suggest recombinant human growth hormone (rhGH) does not fully restore final height (FH) to the predicted mid-parental height (MPH) in CCS.
  • Further analysis of FH outcomes in CCS treated with rhGH is warranted.

Purpose of the Study:

  • To evaluate final height (FH) outcomes in childhood cancer survivors (CCS) treated with recombinant human growth hormone (rhGH).
  • To compare FH in CCS who received different types of radiotherapy (cranial vs. craniospinal/TBI).
  • To identify factors influencing final height in this population.

Main Methods:

  • Retrospective analysis of 87 childhood cancer survivors (CCS) treated with rhGH for growth hormone deficiency (GHD).
  • Patients were stratified into two groups based on radiotherapy: cranial irradiation or non-irradiated tumors (Group A) vs. craniospinal or total body irradiation (TBI) (Group B).
  • Some patients received gonadotropin-releasing hormone analogues (GnRHa) in addition to rhGH.

Main Results:

  • rhGH treatment resulted in height gain but mean final height (FH) was not significantly different from baseline height SDS and remained below mid-parental height (MPH).
  • 67% of patients did not reach their MPH, with significantly poorer outcomes in Group B (craniospinal/TBI).
  • Baseline height and delay in starting rhGH were significant predictors of FH; GnRHa addition did not significantly alter FH.

Conclusions:

  • rhGH and GnRH analogues therapy, while not achieving catch-up growth to MPH, effectively prevented further height loss in CCS with GHD.
  • Final height was within the normal range but statistically significantly below MPH, particularly in patients who underwent craniospinal or total body irradiation (TBI).
  • This highlights the need for careful management and realistic expectations for growth outcomes in irradiated CCS.
Abstract

Keywords:
Cancer survivorsFinal heightGnRH analoguesGrowth hormone

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