Growth hormone and gastrointestinal malignancy: An intriguing link

Area of Science:

• Endocrinology
• Gastroenterology
• Oncology

Background:

• Growth hormone (GH) excess, as seen in acromegaly, is linked to systemic complications, including a higher risk of gastrointestinal (GI) neoplasms.
• Colorectal adenomas and carcinomas are the most frequently reported GI neoplasms associated with GH excess.

Purpose of the Study:

• To review the association between GH excess and GI neoplasms.
• To explore pathogenic mechanisms and clinical management guidelines for colorectal neoplasms in patients with GH excess.

Main Methods:

• Literature review of studies investigating GH excess and GI neoplasms.
• Analysis of pathogenic mechanisms including GH-IGF-1 signaling, and other contributing factors.
• Examination of current screening and follow-up colonoscopy guidelines for acromegaly patients.

Main Results:

• GH excess is associated with an increased incidence of GI neoplasms, particularly colorectal adenomas and carcinomas.
• Pathogenic mechanisms involve GH-Insulin-like Growth Factor 1 (IGF-1) signaling, promoting proliferation and inhibiting apoptosis.
• Conflicting data exists on colon cancer-specific mortality, with some recent studies showing no difference compared to controls.

Conclusions:

• Acromegaly patients with GH excess have an increased risk of GI neoplasms, necessitating initial screening colonoscopies.
• Follow-up colonoscopy recommendations vary based on initial findings and GH excess remission status.
• Current evidence does not indicate an increased risk of colorectal cancer in patients receiving recombinant GH therapy.