New Neoplasm During GH Replacement in Adults With Pituitary Deficiency Following Malignancy: A KIMS Analysis

TY - JOUR

T1 - New Neoplasm During GH Replacement in Adults With Pituitary Deficiency Following Malignancy

T2 - A KIMS Analysis

AU - Krzyzanowska-Mittermayer, Katarzyna

AU - Mattsson, Anders F

AU - Maiter, Dominique

AU - Feldt-Rasmussen, Ulla

AU - Camacho-Hübner, Cecilia

AU - Luger, Anton

AU - Abs, Roger

N1 - Copyright © 2017 Endocrine Society

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Context: Data on the association between growth hormone (GH) replacement in patients with GH deficiency (GHD) after malignancies and new neoplasms show conflicting results. Objective: To clarify the incidence of new malignant neoplasm in childhood-onset (CO) and adultonset (AO) adult cancer survivors (CSs). Design: Retrospective comparison of CO-CS and AO-CS with CO idiopathic GHD (IGHD) and AO nonfunctioning pituitary adenoma (NFPA) patients and with the general population [standardized incidence ratio (SIR)]. Setting: Data from the Pfizer International Metabolic Database study (KIMS). Patients: CO-CS [n = 349; 50.4% females; mean baseline (MBL) IGF-I standard deviation score (SDS), 22.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, 23.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, 21.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, 21.0). Main Outcome Measures: SIRs of malignant neoplasms. Results: After a median follow-up of 5.9 years (2192 patient-years), 15 CO-CS (4.3%) had developed 16 new neoplasms. The SIR was 10.4 [95% confidence interval (CI), 5.9 to 16.9] and 6.5 (95% CI, 3.0 to 12.4) after exclusion of seven patients with skin cancers. In IGHD, three malignant neoplasms (0.5%) were observed after a median follow-up of 5.4 years (3908 patient-years; SIR, 0.47; 95% CI, 0.09 to 1.37). New malignant neoplasms occurred in three AO-CS (1.7%; SIR, 1.1; 95% CI, 0.2 to 3.2) and 146 NFPA patients (153 cases, 6.0%; SIR, 1.1; 95% CI, 0.9 to 1.2) after a median follow-up of 4.9 (1024 patient-years) and 5.6 years (15,215 patient-years). Conclusions: The risk of second malignant neoplasms was increased in CO-CS but not in AO-CS, which illustrates the need to closely follow patients on GH replacement because of a prior malignancy.

AB - Context: Data on the association between growth hormone (GH) replacement in patients with GH deficiency (GHD) after malignancies and new neoplasms show conflicting results. Objective: To clarify the incidence of new malignant neoplasm in childhood-onset (CO) and adultonset (AO) adult cancer survivors (CSs). Design: Retrospective comparison of CO-CS and AO-CS with CO idiopathic GHD (IGHD) and AO nonfunctioning pituitary adenoma (NFPA) patients and with the general population [standardized incidence ratio (SIR)]. Setting: Data from the Pfizer International Metabolic Database study (KIMS). Patients: CO-CS [n = 349; 50.4% females; mean baseline (MBL) IGF-I standard deviation score (SDS), 22.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, 23.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, 21.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, 21.0). Main Outcome Measures: SIRs of malignant neoplasms. Results: After a median follow-up of 5.9 years (2192 patient-years), 15 CO-CS (4.3%) had developed 16 new neoplasms. The SIR was 10.4 [95% confidence interval (CI), 5.9 to 16.9] and 6.5 (95% CI, 3.0 to 12.4) after exclusion of seven patients with skin cancers. In IGHD, three malignant neoplasms (0.5%) were observed after a median follow-up of 5.4 years (3908 patient-years; SIR, 0.47; 95% CI, 0.09 to 1.37). New malignant neoplasms occurred in three AO-CS (1.7%; SIR, 1.1; 95% CI, 0.2 to 3.2) and 146 NFPA patients (153 cases, 6.0%; SIR, 1.1; 95% CI, 0.9 to 1.2) after a median follow-up of 4.9 (1024 patient-years) and 5.6 years (15,215 patient-years). Conclusions: The risk of second malignant neoplasms was increased in CO-CS but not in AO-CS, which illustrates the need to closely follow patients on GH replacement because of a prior malignancy.

KW - Adenoma/complications

KW - Adolescent

KW - Adult

KW - Cancer Survivors/statistics & numerical data

KW - Child

KW - Databases, Factual

KW - Female

KW - Follow-Up Studies

KW - Hormone Replacement Therapy/adverse effects

KW - Human Growth Hormone/adverse effects

KW - Humans

KW - Hypopituitarism/drug therapy

KW - Male

KW - Middle Aged

KW - Neoplasms, Second Primary/chemically induced

KW - Pituitary Neoplasms/complications

KW - Retrospective Studies

KW - Young Adult

U2 - 10.1210/jc.2017-01899

DO - 10.1210/jc.2017-01899

M3 - Journal article

C2 - 29228199

SN - 0021-972X

VL - 103

SP - 523

EP - 531

JO - The Journal of clinical endocrinology and metabolism

JF - The Journal of clinical endocrinology and metabolism

IS - 2

ER -