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Quiroz-Aldave JE, Gamarra-Osorio ER, Durand-Vásquez MDC, Rafael-Robles LDP, Gonzáles-Yovera JG, Quispe-Flores MA, Concepción-Urteaga LA, Román-González A, Paz-Ibarra J, Concepción-Zavaleta MJ. From liver to hormones: The endocrine consequences of cirrhosis. World J Gastroenterol 2024; 30:1073-1095. [PMID: 38577191 PMCID: PMC10989500 DOI: 10.3748/wjg.v30.i9.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Hepatocrinology explores the intricate relationship between liver function and the endocrine system. Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption. Despite its importance, assessing endocrine issues in cirrhotic patients is frequently neglected. This article provides a comprehensive review of the epidemiology, pathophysiology, diagnosis, and treatment of endocrine disturbances in liver cirrhosis. The review was conducted using the PubMed/Medline, EMBASE, and Scielo databases, encompassing 172 articles. Liver cirrhosis is associated with endocrine disturbances, including diabetes, hypoglycemia, sarcopenia, thyroid dysfunction, hypogonadotropic hypogonadism, bone disease, adrenal insufficiency, growth hormone dysfunction, and secondary hyperaldosteronism. The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system, respectively. Sarcopenia can be assessed through imaging and functional tests, while other endocrine disorders are evaluated using hormonal assays and imaging studies. Treatment options include metformin, glucagon-like peptide-1 analogs, sodium-glucose co-transporter-2 inhibitors, and insulin, which are effective and safe for diabetes control. Established standards are followed for managing hypoglycemia, and hormone replacement therapy is often necessary for other endocrine dysfunctions. Liver transplantation can address some of these problems.
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Affiliation(s)
| | | | | | | | | | | | | | - Alejandro Román-González
- Department of Endocrinology, Hospital Universitario de San Vicente Fundación, Medellin 050010, Colombia
- Internal Medicine, Universidad de Antioquia, Medellín 050010, Colombia
| | - José Paz-Ibarra
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
- Department of Endocrinology, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
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Jackson K, Packer RJ. Recent Advances in Pediatric Medulloblastoma. Curr Neurol Neurosci Rep 2023; 23:841-848. [PMID: 37943476 PMCID: PMC10724301 DOI: 10.1007/s11910-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW Review recent advances in the understanding of pediatric medulloblastoma including etiology, biology, radiology, and management of pediatric medulloblastoma. RECENT FINDINGS The classic four subgroups have been reclassified and further subdivided based on new molecular findings. Research is revealing the cell origins of the different subtypes of medulloblastoma. There has been continued personalization of management based on molecular parameters. While many advances have been made in the knowledge base of this most common malignant pediatric brain tumor, there has not yet been translation into more effective therapies to prolong survival in all subgroups with the possible exception of children with group 3 disease. Quality of life remains a major challenge for long-term survivors.
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Affiliation(s)
- Kasey Jackson
- Brain Tumor Institute, Children's National Hospital, Washington D C, USA.
- Division of Hematology and Oncology, Children's National Hospital, Washington D C, USA.
| | - Roger J Packer
- Brain Tumor Institute, Children's National Hospital, Washington D C, USA
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington D C, USA
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3
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van Schaik J, Kormelink E, Kabak E, van Dalen EC, Schouten-van Meeteren AYN, de Vos-Kerkhof E, Bakker B, Fiocco M, Hoving EW, Tissing WJE, van Santen HM. Safety of Growth Hormone Replacement Therapy in Childhood-Onset Craniopharyngioma: A Systematic Review and Cohort Study. Neuroendocrinology 2023; 113:987-1007. [PMID: 37231961 DOI: 10.1159/000531226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Survival of childhood-onset craniopharyngioma (cCP) is excellent; however, many survivors suffer from hypothalamic-pituitary dysfunction. Growth hormone replacement therapy (GHRT) is of high importance for linear growth and metabolic outcome. Optimal timing for initiation of GHRT in cCP is on debate because of concerns regarding tumor progression or recurrence. METHODS A systematic review and cohort studys were performed for the effect and timing of GHRT on overall mortality, tumor progression/recurrence, and secondary tumors in cCP. Within the cohort, cCP receiving GHRT ≤1 year after diagnosis were compared to those receiving GHRT >1 year after diagnosis. RESULTS Evidence of 18 included studies, reporting on 6,603 cCP with GHRT, suggests that GHRT does not increase the risk for overall mortality, progression, or recurrent disease. One study evaluated timing of GHRT and progression/recurrence-free survival and found no increased risk with earlier initiation. One study reported a higher than expected prevalence of secondary intracranial tumors compared to a healthy population, possibly confounded by radiotherapy. In our cohort, 75 of 87 cCP (86.2%) received GHRT for median of 4.9 years [0.0-17.1]. No effect of timing of GHRT was found on mortality, progression/recurrence-free survival, or secondary tumors. CONCLUSION Although the quality of the evidence is low, the available evidence suggests no effect of GHRT or its timing on mortality, tumor progression/recurrence, or secondary neoplasms in cCP. These results support early initiation of GHRT in cCP aiming to optimize linear growth and metabolic outcome. Prospective studies are needed to increase the level of evidence upon the optimal timing to start GHRT in cCP patients.
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Affiliation(s)
- Jiska van Schaik
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Eline Kormelink
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eda Kabak
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Boudewijn Bakker
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Institute of Mathematics, Leiden University, Leiden, The Netherlands
| | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke M van Santen
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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4
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Ronsley R, Lazow M, Henry RK. Growth hormone after CNS tumor diagnosis: the fundamentals, fears, facts, and future directions. Pediatr Hematol Oncol 2023; 40:786-799. [PMID: 36939305 DOI: 10.1080/08880018.2023.2190765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Abstract
Growth hormone deficiency (GHD) may occur in pediatric patients with central nervous system (CNS) tumors at initial tumor presentation or later as treatment-related sequelae. While it is well recognized that growth hormone (GH) has beneficial effects on growth and endocrinopathies, there's often hesitancy by clinicians to initiate GH therapy for GHD after CNS tumor diagnosis due to the perceived increased risk of tumor recurrence. The available data is described here and based on this review, there is no evidence of increased risk of tumor recurrence or secondary malignancy in patients treated with GH after CNS tumor diagnosis. Further understanding of tumor biology and presence of downstream GH targets including insulin-like growth factor-1 (IGF-1) and insulin receptor activity is still needed.
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Affiliation(s)
- Rebecca Ronsley
- Section of Hematology, Oncology & BMT, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Section of Hematology, Oncology & BMT, Department of Pediatrics, Seattle Children's Hospital, The University of Washington, Seattle, Washington, USA
| | - Margot Lazow
- Section of Hematology, Oncology & BMT, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rohan K Henry
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Puvilland C, Villanueva C, Hemmendinger A, Kornreich L, Gueorguieva I, Karnoub MA, Beuriat PA, Leblond P. Growth Hormone Replacement Therapy Seems to Be Safe in Children with Low-Grade Midline Glioma: A Series of 124 Cases with Review of the Literature. Cancers (Basel) 2022; 15:cancers15010055. [PMID: 36612052 PMCID: PMC9817711 DOI: 10.3390/cancers15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
There is little scientific evidence regarding the safety of GHRT in LGG, where GH deficiency is common. PURPOSE to compare the recurrence rate in children with midline LGG, depending on whether or not they have received GHRT, in order to assess its impact on the risk of tumor recurrence. METHODS This bicentric retrospective study included 124 patients under the age of 18 who were diagnosed with a midline low-grade glial tumor between 1998 and 2016. We also reviewed literature on this subject. The main outcome measure was tumor relapse, demonstrated by brain MRI. RESULTS There were 17 patients in the GH-supplemented group (14%) and 107 patients in the non-supplemented group (86%). Relapse occurred in 65 patients (45.5%); 7 patients died (4.9%); no deaths occurred in patients receiving GHRT. Two patients developed a second tumor (1.4%), none of which had received GHRT. Relapse concerned 36.4% of patients without GHRT and 52.9% of patients with GHRT. The difference was not statistically significant between the two groups (p = 0.3). CONCLUSION GHRT does not lead to a statistically significant increase in risk of relapse for pediatric midline low-grade pediatric glioma in our cohort. Although these results appear reassuring, future natural history or prospective studies should be done to ascertain these findings. Nevertheless, these reassuring data regarding GHRT are in agreement with the data in the current literature.
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Affiliation(s)
- Coline Puvilland
- Pediatric Endocrinology Unit, Woman Mother Child Hospital, Lyon Civil Hospices, 69500 Bron, France
- Pediatric Unit, Hospital Fleyriat, 01012 Bourg-en-Bresse, France
- Correspondence: ; Tel.: +33-648035223
| | - Carine Villanueva
- Pediatric Endocrinology Unit, Woman Mother Child Hospital, Lyon Civil Hospices, 69500 Bron, France
| | | | - Laure Kornreich
- Department of Hematology and Oncology, Queen Fabiola Children’s University Hospital, 1020 Brussels, Belgium
| | - Iva Gueorguieva
- Pediatric Endocrine Unit, Jeanne-de-Flandre Children’s Hospital, 59000 Lille, France
| | - Mélodie-Anne Karnoub
- Department of Pediatric Neurosurgery, Lille University Hospital, 59000 Lille, France
| | - Pierre Aurélien Beuriat
- Department of Pediatric Neurosurgery, Woman Mother Child Hospital, Lyon Civil Hospices, 69500 Bron, France
- Rockfeller School of Medicine, Claude Bernard University Lyon 1, 69100 Villeurbanne, France
| | - Pierre Leblond
- Department of Pediatric Oncology, Institute of Pediatric Hematology and Oncology (IHOPe), Centre Léon Bérard, 69008 Lyon, France
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Kinoshita Y, Yamasaki F, Taguchi A, Takayasu T, Yonezawa U, Tominaga A, Arita K, Okada S, Horie N, Sugiyama K. Influence of growth hormone therapy on germinoma survivors. Pituitary 2022; 25:854-860. [PMID: 35986827 DOI: 10.1007/s11102-022-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Due to the effectiveness of growth hormone therapy (GHT), the number of cancer survivors receiving GHT has increased. Previous studies had indicated that GHT was not associated with the increasing risks of tumor recurrence and development with second neoplasm (SN) in cancer survivors. However, to date, research on those risks in germinoma survivors is still limited. The aim of this study is to evaluate the impact of GHT in relation to tumor recurrence and development with SN in pure germinoma survivors. METHODS This retrospective cohort study was approved by the Ethical Committee for Epidemiology of our institution. Seventy-three consecutive patients who underwent a biopsy of the lesion and were diagnosed with pure germinoma were retrospectively studied. They (median age, 15.0 years) were followed up more than 1 year after biopsy (median follow-up period, 14.3 years). The following data was obtained from the medical records of the patients: age, sex, preoperative magnetic resonance imaging findings, hormonal replacement, and events including tumor recurrence and/or SN. RESULTS In our patient series, 16 patients (21.9%) who were more likely to have neurohypophysial lesion and receive multiple hormonal therapies had received GHT. No significant differences in the rates of tumor recurrence and development with SN were observed between the patients who had and had not received GHT. Moreover, the recurrence-free survival and overall survival rates were not different between the patients who had and had not received GHT. CONCLUSIONS GHT did not increase the risks of tumor recurrence and development with SN in pure germinoma survivors.
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Affiliation(s)
- Yasuyuki Kinoshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan.
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Atsushi Tominaga
- Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
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Doycheva I, Erickson D, Watt KD. Growth hormone deficiency and NAFLD: An overlooked and underrecognized link. Hepatol Commun 2022; 6:2227-2237. [PMID: 35765700 PMCID: PMC9426379 DOI: 10.1002/hep4.1953] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/17/2022] Open
Abstract
Growth hormone and its mediator insulin‐like growth factor‐1 exert their effect on different organs and control various physiologic metabolic processes. Adult growth hormone deficiency (AGHD) presents with one or more components of metabolic syndrome and can be associated with nonalcoholic fatty liver disease (NAFLD). AGHD is present in spectrum of hypothalamic/pituitary disorders as well as cranial radiation of brain tumors and often remains underdiagnosed or untreated due to its nonspecific symptoms, relatively difficult diagnosis in some clinical scenarios, and various barriers to treatment. NAFLD usually develops soon after diagnosis of AGHD and might progress rapidly to nonalcoholic steatohepatitis (NASH) with advanced fibrosis, eventually requiring liver transplantation. A timely initiation of growth hormone replacement therapy might be important, although studies so far have demonstrated controversial results on NAFLD, primarily due to small sample size and different diagnostic methods of NAFLD. Increased awareness of the association between AGHD and NAFLD would facilitate early diagnosis of NAFLD and NASH if present. Therefore, a multidisciplinary approach involving hepatology and endocrinology should become a standard of care for these patients.
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Affiliation(s)
- Iliana Doycheva
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Dana Erickson
- Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Kymberly D Watt
- Gastroenterology and Hepatology Department, Mayo Clinic, Rochester, Minnesota, USA
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8
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Sodero G, Agresti P, Triarico S, Romano A, Mastrangelo S, Attinà G, Maurizi P, Cipolla C, Ruggiero A. Growth Hormone replacement therapy in pediatric brain tumor survivors. Minerva Pediatr (Torino) 2022; 74:340-348. [PMID: 35142454 DOI: 10.23736/s2724-5276.22.06799-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brain tumors are the most frequent type of solid neoplasms in children with a recognized 5-year survival rate between 57 and 65%. The survival rate progressively increased in the last few years, due to the improvements in their treatment based on chemotherapy, radiotherapy, and surgery. At the same time, at long term follow-up, clinicians should carefully evaluate comorbidities and long term sequelae secondary to the disease and its treatment. Growth Hormone Deficiency (GHD) is an endocrinopathy commonly found among pediatric cancer survivors, with a negative effect on the child's final height and entire metabolism. GH replacement therapy (GHRT), with a synthetic hormone analog, may improve the growth rate and finally adult height, ameliorating the quality of life after cancer treatment. However, in clinical practice, GHRT is adopted with caution for fear of cancer recurrence or the onset of second malignancies. In our review, we perform a focus on the GH structure and function, comparing benefits and risks of GHRT, derived from the analysis of the data currently available in the literature.
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Affiliation(s)
- Giorgio Sodero
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Pierpaolo Agresti
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Università Cattolica del Sacro Cuore Sede di Roma, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Clelia Cipolla
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Università Cattolica del Sacro Cuore Sede di Roma, Italy
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9
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Boguszewski MCS, Cardoso-Demartini AA, Boguszewski CL, Chemaitilly W, Higham CE, Johannsson G, Yuen KCJ. Safety of growth hormone (GH) treatment in GH deficient children and adults treated for cancer and non-malignant intracranial tumors-a review of research and clinical practice. Pituitary 2021; 24:810-827. [PMID: 34304361 PMCID: PMC8416866 DOI: 10.1007/s11102-021-01173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Individuals surviving cancer and brain tumors may experience growth hormone (GH) deficiency as a result of tumor growth, surgical resection and/or radiotherapy involving the hypothalamic-pituitary region. Given the pro-mitogenic and anti-apoptotic properties of GH and insulin-like growth factor-I, the safety of GH replacement in this population has raised hypothetical safety concerns that have been debated for decades. Data from multicenter studies with extended follow-up have generally not found significant associations between GH replacement and cancer recurrence or mortality from cancer among childhood cancer survivors. Potential associations with secondary neoplasms, especially solid tumors, have been reported, although this risk appears to decline with longer follow-up. Data from survivors of pediatric or adult cancers who are treated with GH during adulthood are scarce, and the risk versus benefit profile of GH replacement of this population remains unclear. Studies pertaining to the safety of GH replacement in individuals treated for nonmalignant brain tumors, including craniopharyngioma and non-functioning pituitary adenoma, have generally been reassuring with regards to the risk of tumor recurrence. The present review offers a summary of the most current medical literature regarding GH treatment of patients who have survived cancer and brain tumors, with the emphasis on areas where active research is required and where consensus on clinical practice is lacking.
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Affiliation(s)
- Margaret C S Boguszewski
- Departamento de Pediatria, Universidade Federal do Paraná, Avenida Agostinho Leão Junior, 285 - Alto da Glória, Curitiba, PR, 80030-110, Brazil.
| | | | - Cesar Luiz Boguszewski
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Wassim Chemaitilly
- Departments of Pediatric Medicine-Endocrinology and Epidemiology-Cancer Control, St. Jude Children's Research Hospital, Memphis, USA
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gudmundur Johannsson
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, Departments of Neuroendocrinology and Neurosurgery, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
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Management of incidental brain tumors in children: a systematic review. Childs Nerv Syst 2020; 36:1607-1619. [PMID: 32377829 DOI: 10.1007/s00381-020-04658-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Due to technical advancements and availability of neuroimaging, detection of incidental pediatric brain tumors (IPBT) is growing rapidly. The management of these asymptomatic lesions remains unclear; radiological, pathological, and clinical risk factors for further growth and malignant transformation (MT) are not well defined. METHODS We systematically reviewed the literature on the dilemmas and management of IPBT suggestive of a low-grade brain tumor (LGBT). Keyword searches of the PubMed and Medline (NCBI) databases identified studies on IPBT describing the prevalence, neuroimaging, management, or risk of MT through July 2019. References of the identified articles were also reviewed. RESULTS A total of 2021 records were screened. Fifty-nine full-text articles were reviewed, and 34 published studies were included. IPBT are diagnosed in 0.2-5.7% of children undergoing brain imaging for various reasons. The accepted approach for management of lesions showing radiological characteristics suggestive of LGBT is radiological follow-up. The rate at which additional intervention is required during follow-up for these apparently low-grade lesions is 9.5%. Nevertheless, the dilemma of early surgical resection or biopsy vs. clinical and radiological follow-up of IPBT is still unresolved. The risk in these cases is missing a transformation to a higher grade tumor. However, MT of pediatric LGBT is very rare, occurring in less than 3% of the cases of proven low-grade gliomas in children. The risk of future MT in pediatric low-grade gliomas seems to be greater in the presence of specific molecular markers such as BRAF V-600E, CDKN2A, and H3F3A K27M. CONCLUSIONS The natural history, management, and prognosis of IPBT remain ambiguous. It seems that lesions suggestive of LGBT can initially be followed, since many of these lesions remain stable over time and MT is rare. However, controversy among centers concerning the ideal approach still exists. Further observational and prospective cohort studies, focusing on potential clinical and radiological characteristics or risk factors suggestive of high-grade tumors, tumor progress, or MT of IPBT, are needed.
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11
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New insights into the protection of growth hormone in cisplatin-induced nephrotoxicity: The impact of IGF-1 on the Keap1-Nrf2/HO-1 signaling. Life Sci 2020; 253:117581. [PMID: 32209424 DOI: 10.1016/j.lfs.2020.117581] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022]
Abstract
AIMS Cisplatin (CDDP) is an effective antineoplastic agent, however, its serious nephrotoxicity limits therapeutic use. Human growth hormone (hGH) has proved antioxidant and anti-inflammatory activities. The present study aimed to investigate the nephroprotective effects of hGH against CDDP-induced nephrotoxicity and the mechanisms underlying this nephroprotection. MAIN METHODS Male albino rats injected with CDDP (7 mg/kg) and nephrotoxicity indices, oxidative stress and inflammatory biomarkers (high mobility group box protein-1 (HMGB-1), soluble epoxide hydrolase (sEH), and nuclear factor-kappa B (NF-κB)) were assessed. Also, insulin-like growth factor-1 (IGF-1) and Nuclear factor-erythroid-2 (Nrf2)/heme oxygenase-1 (HO-1) pathway were assessed. KEY FINDINGS hGH (1 mg/kg) improved kidney function and antioxidant systems and showed intact renal tubular epithelium. Cisplatin upregulated the HMGB-1/NF-κB and downregulated Nrf2/HO-1 pathways which were reversed by hGH and aligned with increased renal IGF-1 expression. Also, IGF-1/sEH crosstalk might be involved in hGH nephroprotection. Moreover, hGH downregulated HSP70 and caspase-3 expressions. SIGNIFICANCE these results concluded that hGH can attenuate the inflammation and oxidative stress attained by CDDP probably through inhibition of Nrf2/HO-1 pathway. We also suggested that Keap1/Nrf2-mediated upregulation of the antioxidant HO-1 might inhibit HMGB-1/NF-κB signaling and thus provide the principal protection mechanism offered by hGH against CDDP-induced kidney injury.
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Freda PU, Bruce JN, Khandji AG, Jin Z, Hickman RA, Frey E, Reyes-Vidal C, Otten M, Wardlaw SL, Post KD. Presenting Features in 269 Patients With Clinically Nonfunctioning Pituitary Adenomas Enrolled in a Prospective Study. J Endocr Soc 2020; 4:bvaa021. [PMID: 32258955 PMCID: PMC7101088 DOI: 10.1210/jendso/bvaa021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
Context Clinically nonfunctioning pituitary adenomas (CNFPAs) typically remain undetected until mass effect symptoms develop. However, currently, head imaging is performed commonly for many other indications, which may increase incidental discovery of CNFPAs. Since current presentation and outcome data are based on older, retrospective series, a prospective characterization of a contemporary CNFPA cohort was needed. Objective To determine the prevalence of incidental presentation and hypopituitarism and its predictors in a CNFPA cohort that spanned 6 to 9 mm micro- to macroadenoma included observational and surgical therapy. Methods At enrollment in a prospective, observational study, 269 patients with CNFPAs were studied by history, examination, blood sampling, and pituitary imaging analysis and categorized into incidental or symptoms presentation groups that were compared. Results Presentation was incidental in 48.7% of patients and due to tumor symptoms in 51.3%. In the symptoms and incidental groups, 58.7% and 27.4% of patients had hypopituitarism, respectively, and 25% of patients with microadenomas had hypopituitarism. Many had unappreciated signs and symptoms of pituitary disease. Most tumors were macroadenomas (87%) and were larger in the symptoms than incidental and hypopituitary groups than in the eupituitary groups. The patients in the incidental group were older, and males were older and had larger tumors in both the incidental and symptoms groups. Conclusions Patients with CNFPAs commonly present incidentally and with previously unrecognized hypopituitarism and symptoms that could have prompted earlier diagnosis. Our data support screening all large micro and macro-CNFPAs for hypopituitarism. Most patients with CNFPAs still have mass effect signs at presentation, suggesting the need for more awareness of pituitary disease. Our ongoing, prospective observation of this cohort will assess outcomes of these CNFPA groups.
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Affiliation(s)
- Pamela U Freda
- Departments of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jeffrey N Bruce
- Departments of Neurosurgery, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Alexander G Khandji
- Departments of Radiology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Zhezhen Jin
- Departments of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Richard A Hickman
- Departments of Pathology and Cell Biology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Emily Frey
- Departments of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Carlos Reyes-Vidal
- Departments of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Marc Otten
- Departments of Neurosurgery, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Sharon L Wardlaw
- Departments of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Kalmon D Post
- Departments of Neurosurgery, Mount Sinai School of Medicine, New York, New York
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13
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Outcome of Endoscopic Endonasal Surgery in Pediatric Craniopharyngiomas. World Neurosurg 2019; 134:e277-e288. [PMID: 31629927 DOI: 10.1016/j.wneu.2019.10.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the last years, few reports have shown the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas in pediatric patients. For these tumors, recent studies have suggested less aggressive surgery, favoring the preservation of the patient's quality of life. OBJECTIVE The aim of this study was to assess the outcome of the EEA in a large series with specific attention on the long-term functional sequelae. MATERIALS All consecutive pediatric craniopharyngiomas operated on through this approach since 2000 were included in the study. Preoperative and postoperative operative clinical, radiologic, and pathologic features were retrieved from patient records (mean follow-up, 72 ± 67 months). RESULTS The series included 25 patients (12 female; mean age, 8.9 ± 4.1 years). Most of the tumors presented with a supradiaphragmatic extension (88%). Removal was radical in 23 patients (92%). Complications consisted of 6 cerebrospinal fluid leaks (24%). One patient (4%) died of postoperative respiratory complications. Most patients (92%) developed panhypopituitarism and visual disturbances normalized or improved in 6 patients (43%). At follow-up, 9 patients (36%) were overweight/obese (6 were already overweight before surgery). The tumor recurrence rate was 19%. CONCLUSIONS EEA can be an effective approach for midline craniopharyngiomas in children older than 3 years. It gives a satisfactory exposure of the suprasellar region and an adequate assessment of the brain-tumor interface. Its main limitations are age-related anatomic features of nasal/paranasal sinuses and the risk of cerebrospinal fluid leak.
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14
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Rhie YJ, Yoo JH, Choi JH, Chae HW, Kim JH, Chung S, Hwang IT, Shin CH, Kim EY, Kim HS. Long-term safety and effectiveness of growth hormone therapy in Korean children with growth disorders: 5-year results of LG Growth Study. PLoS One 2019; 14:e0216927. [PMID: 31095622 PMCID: PMC6522217 DOI: 10.1371/journal.pone.0216927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/24/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this registry study was to analyze the long-term safety and effectiveness of recombinant human growth hormone (rhGH) in South Korean pediatric patients (≥2 years of age) with growth hormone deficiency GHD) of idiopathic or organic etiology, idiopathic short stature, Turner syndrome, small for gestational age and chronic renal failure. METHODS The study patients were followed-up till two years after the epiphyseal closure, with visits scheduled every six months. The outcome measures included the incidence of adverse events (AEs, in particular, neoplasia, glucose intolerance and hypothyroidism), as well as height standard deviation score (Ht SDS) and annual height velocity. The results of the interim analysis of a 5-year accumulated data for 2,024 patients (7,342 patient-years, PY) are presented. RESULTS A total of 14 neoplasms were diagnosed (191/100,000 PY); 7 out of 9 malignancies were recurrent craniopharyngioma found in patients with organic GHD. Seven cases of glucose intolerance (95/100,000 PY) and 22 cases of hypothyroidism (300/100,000 PY) were detected; about half of the cases (4 and 10 cases each) were considered to be related with rhGH treatment. Most of the growth-retarded patients showed continuous improvement in Ht SDS, with the most prominent effect observed within a year of treatment initiation. The beneficial effect of rhGH on Ht SDS gain was maintained for 2-4 years. CONCLUSIONS The incidence of AEs of interest in rhGH-treated patients was low, and most of the neoplasms were benign and/or non-related to rhGH. Most patients benefited from the therapy in terms of height increment.
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Affiliation(s)
- Young-Jun Rhie
- Department of Pediatrics, Korea University College of Medicine, Ansan, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, College of Medicine, Dong-A University, Busan, Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Il Tae Hwang
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | | | - Ho-Seong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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15
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Remes TM, Suo-Palosaari MH, Heikkilä VP, Sutela AK, Koskenkorva PKT, Toiviainen-Salo SM, Porra L, Arikoski PM, Lähteenmäki PM, Pokka TML, Arola MO, Riikonen VP, Sirkiä KH, Lönnqvist TRI, Rantala HMJ, Ojaniemi MK, Harila-Saari AH. Radiation-Induced Meningiomas After Childhood Brain Tumor: A Magnetic Resonance Imaging Screening Study. J Adolesc Young Adult Oncol 2019; 8:593-601. [PMID: 31063432 DOI: 10.1089/jayao.2019.0010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Childhood brain tumors (CBTs) and their treatment increase the risk of secondary neoplasms (SNs). We studied the incidence of secondary craniospinal tumors with magnetic resonance imaging (MRI) screening in a national cohort of survivors of CBT treated with radiotherapy, and we analyzed the Finnish Cancer Registry (FCR) data on SNs in survivors of CBT with radiotherapy registered as a part of the primary tumor treatment. Methods: A total of 73 survivors of CBT participated in the MRI study (mean follow-up of 19 ± 6.2 years). The incidence of SNs in a cohort of CBT patients (N = 569) was retrieved from the FCR (mean follow-up of 11 ± 12.9 years). Brain tumors were diagnosed at age ≤16 years between the years 1970 and 2008 in the clinical study and the years 1963 and 2010 in the FCR population. Results: Secondary brain tumors, meningiomas in all and schwannoma in one, were found in 6 of the 73 (8.2%) survivors with a mean of 23 ± 4.3 years after the diagnosis of the primary tumor. The cumulative incidence was 10.2% (95% confidence interval [CI] 3.9-25.1) in 25 years of follow-up. In the FCR data, the 25-year cumulative incidence of SNs was 2.4% (95% CI 1.3-4.1); only two brain tumors, no meningiomas, were registered. Conclusion: Survivors of CBT treated with radiotherapy have a high incidence of meningiomas, which are rarely registered in the FCR.
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Affiliation(s)
- Tiina M Remes
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria H Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Vesa-Pekka Heikkilä
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Anna K Sutela
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Sanna-Maria Toiviainen-Salo
- Department of Pediatric Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Liisa Porra
- Department of Radiation Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Pekka M Arikoski
- Department of Pediatrics and Adolescence, Kuopio University Hospital, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescence, Turku University Hospital and Turku University, Turku, Finland
| | - Tytti M-L Pokka
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko O Arola
- Department of Pediatrics and Adolescence, Tampere University Hospital, Tampere, Finland
| | - V Pekka Riikonen
- Department of Pediatrics and Adolescence, Kuopio University Hospital, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland
| | - Kirsti H Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
| | - Tuula R I Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki M J Rantala
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja K Ojaniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arja H Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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16
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Boguszewski CL, Boguszewski MCDS. Growth Hormone's Links to Cancer. Endocr Rev 2019; 40:558-574. [PMID: 30500870 DOI: 10.1210/er.2018-00166] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Several components of the GH axis are involved in tumor progression, and GH-induced intracellular signaling has been strongly associated with breast cancer susceptibility in genome-wide association studies. In the general population, high IGF-I levels and low IGF-binding protein-3 levels within the normal range are associated with the development of common malignancies, and components of the GH-IGF signaling system exhibit correlations with clinical, histopathological, and therapeutic parameters in cancer patients. Despite promising findings in preclinical studies, anticancer therapies targeting the GH-IGF signaling system have led to disappointing results in clinical trials. There is substantial evidence for some degree of protection against tumor development in several animal models and in patients with genetic defects associated with GH deficiency or resistance. In contrast, the link between GH excess and cancer risk in acromegaly patients is much less clear, and cancer screening in acromegaly has been a highly controversial issue. Recent studies have shown that increased life expectancy in acromegaly patients who attain normal GH and IGF-I levels is associated with more deaths due to age-related cancers. Replacement GH therapy in GH deficiency hypopituitary adults and short children has been shown to be safe when no other risk factors for malignancy are present. Nevertheless, the use of GH in cancer survivors and in short children with RASopathies, chromosomal breakage syndromes, or DNA-repair disorders should be carefully evaluated owing to an increased risk of recurrence, primary cancer, or second neoplasia in these individuals.
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Affiliation(s)
- Cesar Luiz Boguszewski
- Department of Internal Medicine, Endocrine Division (SEMPR), University Hospital, Federal University of Parana, Curitiba, Brazil
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17
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Child CJ, Zimmermann AG, Chrousos GP, Cummings E, Deal CL, Hasegawa T, Jia N, Lawrence S, Linglart A, Loche S, Maghnie M, Pérez Sánchez J, Polak M, Predieri B, Richter-Unruh A, Rosenfeld RG, Yeste D, Yorifuji T, Blum WF. Safety Outcomes During Pediatric GH Therapy: Final Results From the Prospective GeNeSIS Observational Program. J Clin Endocrinol Metab 2019; 104:379-389. [PMID: 30219920 PMCID: PMC6300411 DOI: 10.1210/jc.2018-01189] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/10/2018] [Indexed: 02/06/2023]
Abstract
Context Safety concerns have been raised regarding premature mortality, diabetes, neoplasia, and cerebrovascular disease in association with GH therapy. Objective To assess incidence of key safety outcomes. Design Prospective, multinational, observational study (1999 to 2015). Setting A total of 22,311 GH-treated children from 827 investigative sites in 30 countries. Patients Children with growth disorders. Interventions GH treatment. Main outcome measures Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% CIs for mortality, diabetes, and primary cancer using general population registries. Results Predominant short stature diagnoses were GH deficiency (63%), idiopathic short stature (13%), and Turner syndrome (8%), with mean ± SD follow-up of 4.2 ± 3.2 years (∼92,000 person-years [PY]). Forty-two deaths occurred in patients with follow-up, with an SMR (95% CI) of 0.61 (0.44, 0.82); the SMR was elevated for patients with cancer-related organic GH deficiency [5.87 (3.21, 9.85)]. Based on 18 cases, type 2 diabetes mellitus (T2DM) risk was elevated [SIR: 3.77 (2.24, 5.96)], but 72% had risk factors. In patients without cancer history, 14 primary cancers were observed [SIR: 0.71 (0.39, 1.20)]. Second neoplasms occurred in 31 of 622 cancer survivors [5.0%; 10.7 (7.5, 15.2) cases/1000 PY] and intracranial tumor recurrences in 67 of 823 tumor survivors [8.1%; 16.9 (13.3, 21.5) cases/1000 PY]. All three hemorrhagic stroke cases had risk factors. Conclusions GeNeSIS (Genetics and Neuroendocrinology of Short Stature International Study) data support the favorable safety profile of pediatric GH treatment. Overall risk of death or primary cancer was not elevated in GH-treated children, and no hemorrhagic strokes occurred in patients without risk factors. T2DM incidence was elevated compared with the general population, but most cases had diabetes risk factors.
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Affiliation(s)
| | | | - George P Chrousos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Cheri L Deal
- University of Montreal and CHU Ste-Justine, Montreal, Quebec, Canada
| | | | - Nan Jia
- Eli Lilly and Company, Indianapolis, Indiana
| | - Sarah Lawrence
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Sandro Loche
- Ospedale Pediatrico Microcitemico “A. Cao,” AO Brotzu, Cagliari, Italy
| | - Mohamad Maghnie
- Istituto Giannina Gaslini, University of Genova, Genoa, Italy
| | | | - Michel Polak
- Hôpital Universitaire Necker Enfants Malades and Université Paris Descartes, Centre des Maladies Endocrines Rares de la Croissance, Paris, France
| | | | | | | | - Diego Yeste
- Hospital Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Tohru Yorifuji
- Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
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18
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Marinho CG, Mermejo LM, Salvatori R, Assirati JA, Oliveira CRP, Santos EG, Leal ÂCGB, Barros-Oliveira CS, Damascena NP, Lima CA, Farias CT, Moreira AC, Aguiar-Oliveira MH. Occurrence of neoplasms in individuals with congenital, severe GH deficiency from the Itabaianinha kindred. Growth Horm IGF Res 2018; 41:71-74. [PMID: 29571594 DOI: 10.1016/j.ghir.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 11/18/2022]
Abstract
Growth hormone (GH) and the insulin-like growth factor I (IGF-I) have cell proliferative and differentiation properties. Whether these hormones have a role in mutagenesis is unknown. Nevertheless, severe IGF-I deficiency seems to confer protection against the development of neoplasms. Here, we report five cases of adult patients with severe and congenital isolated GH deficiency (IGHD) due to the c.57+1G>A mutation in the GHRH receptor gene, who developed tumors. Four GH-naïve subjects presented skin tumors: a 42-year-old man with a fibroepithelial polyp, a 53-year-old woman and two men (59 and 56 years old) with epidermoid skin cancers. One of these died from it after three surgeries and radiotherapy. The fifth patient was a 25-year-old woman, who had intermittently received GH replacement therapy (GHRT) from age 11 to 18, who developed an ependymoma extending from the fourth ventricle to the end of the thoracic spine. She underwent three surgical procedures, without obvious evidence of tumor recurrence during the six years follow up. These observations suggest that severe IGHD does not protect completely from development of tumors.
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Affiliation(s)
- Cindi G Marinho
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Lívia M Mermejo
- Division of Endocrinology, Faculty of Medicine of Ribeirao Preto of the University of São Paulo (USP), 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore, MD 21287, USA
| | - João A Assirati
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine of Ribeirao Preto of the University of São Paulo (USP), 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Elenilde G Santos
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Ângela C G B Leal
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | | | - Nayra P Damascena
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Carlos A Lima
- Division of Surgery, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Catarine T Farias
- Division of Endocrinology, Federal University of Sergipe, 49060-100 Aracaju, Sergipe, Brazil
| | - Ayrton C Moreira
- Division of Endocrinology, Faculty of Medicine of Ribeirao Preto of the University of São Paulo (USP), 14049-900 Ribeirao Preto, São Paulo, Brazil
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19
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Roth J, Soleman J, Paraskevopoulos D, Keating RF, Constantini S. Incidental brain tumors in children: an international neurosurgical, oncological survey. Childs Nerv Syst 2018; 34:1325-1333. [PMID: 29802595 DOI: 10.1007/s00381-018-3836-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Incidental pediatric brain tumors (IPBT) are increasingly being diagnosed. Currently, there is no consensus regarding the need and timing of their treatment. In the current study, we identify trends among pediatric neurosurgeons and oncologists with regard to IPBT management and approval of growth hormone replacement therapy (GHRT). METHODS A questionnaire presenting six different cases of IPBT was emailed to all members of several leading societies in pediatric neurosurgery and oncology. Collected data included basic information concerning the responders (profession, experience, continent of practice), as well as responses to multiple questions regarding treatment of the lesion, permission to supply GHRT, and free text for comments. RESULTS One hundred forty-three responses were eligible for analysis (92 neurosurgeons, 51 oncologists, from a total of 6 continents). Initial recommendations for each case were heterogeneous. However, a few consistent trends were identified: Lesions that were stable over time lead to a common shift in treatment recommendation to a more conservative one. Growing lesions were commonly treated more aggressively. Neither profession nor experience had a consistent impact on recommendations. CONCLUSIONS Management recommendations for IPBT varied among the responders and seem to be influenced by many factors. However, stable lesions lead to a shift in management towards a "watch and wait" approach, while in growing lesions responders tended towards a "biopsy" or "resection" approach. This highlights the need for better understanding of the natural course of incidental brain tumors in children, as well as evaluating the potential risk for malignant transformation.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
| | - Jehuda Soleman
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Dimitris Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University London, London, UK
| | - Robert F Keating
- Departments of Neurosurgery and Pediatrics, Children's National Medical Center, Washington DC, USA
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
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20
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Krzyzanowska-Mittermayer K, Mattsson AF, Maiter D, Feldt-Rasmussen U, Camacho-Hübner C, Luger A, Abs R. New Neoplasm During GH Replacement in Adults With Pituitary Deficiency Following Malignancy: A KIMS Analysis. J Clin Endocrinol Metab 2018; 103:523-531. [PMID: 29228199 DOI: 10.1210/jc.2017-01899] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023]
Abstract
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 adult-onset (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), -2.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, -3.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, -1.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, -1.0). 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.
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Affiliation(s)
| | | | - Dominique Maiter
- UCL St Luc Hospital, Department of Endocrinology and Nutrition, Brussels, Belgium
| | - Ulla Feldt-Rasmussen
- Copenhagen University, Rigshospitalet, Department of Endocrinology, Copenhagen, Denmark
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University and General Hospital of Vienna, Vienna, Austria
| | - Roger Abs
- Antwerp Centre for Endocrinology, Antwerp, Belgium
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21
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Martínez-Moreno CG, Calderón-Vallejo D, Harvey S, Arámburo C, Quintanar JL. Growth Hormone (GH) and Gonadotropin-Releasing Hormone (GnRH) in the Central Nervous System: A Potential Neurological Combinatory Therapy? Int J Mol Sci 2018; 19:E375. [PMID: 29373545 PMCID: PMC5855597 DOI: 10.3390/ijms19020375] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 12/15/2022] Open
Abstract
This brief review of the neurological effects of growth hormone (GH) and gonadotropin-releasing hormone (GnRH) in the brain, particularly in the cerebral cortex, hypothalamus, hippocampus, cerebellum, spinal cord, neural retina, and brain tumors, summarizes recent information about their therapeutic potential as treatments for different neuropathologies and neurodegenerative processes. The effect of GH and GnRH (by independent administration) has been associated with beneficial impacts in patients with brain trauma and spinal cord injuries. Both GH and GnRH have demonstrated potent neurotrophic, neuroprotective, and neuroregenerative action. Positive behavioral and cognitive effects are also associated with GH and GnRH administration. Increasing evidence suggests the possibility of a multifactorial therapy that includes both GH and GnRH.
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Affiliation(s)
- Carlos G Martínez-Moreno
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Campus Juriquilla, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro 76230, Mexico.
| | - Denisse Calderón-Vallejo
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Av. Universidad 940, Ciudad Universitaria, Aguascalientes 20131, Mexico.
| | - Steve Harvey
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada.
| | - Carlos Arámburo
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Campus Juriquilla, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro 76230, Mexico.
| | - José Luis Quintanar
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Av. Universidad 940, Ciudad Universitaria, Aguascalientes 20131, Mexico.
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Soleman J, Roth J, Ram Z, Yalon M, Constantini S. Malignant transformation of a conservatively managed incidental childhood cerebral mass lesion: controversy regarding management paradigm. Childs Nerv Syst 2017; 33:2169-2175. [PMID: 28808787 DOI: 10.1007/s00381-017-3566-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Incidental findings on neuroimaging in the pediatric population are an emerging treatment challenge. Treatment options for these incidental childhood brain mass lesions, which radiologically may be assumed to be low-grade gliomas (LGG), vary, ranging from careful conservative "wait and scan" treatment to surgical biopsy, gross total resection, and upfront radiation and/or chemotherapy. As malignant transformation of LGG in children is extremely rare, some series advocate careful conservative management of these lesions; however, universal treatment protocols are not totally agreed upon. ILLUSTRATIVE CASE We present the case of a 10-year-old boy with a fronto-basal incidental cerebral mass lesion, suspected to be a low-grade glial neoplasm. Initially, magnetic resonance imaging (MRI) was done to rule out a pathology causing his growth to be delayed. A treatment with growth hormone was initiated. After close clinical and radiological follow-up of this asymptomatic lesion for 6 years, a minimal growth of the lesion was seen, which we decided to continue following. After 7 years, a clear growth with new contrast enhancement was seen on routine MRI. At this point, the lesion was surgically resected. The diagnosis was, surprisingly, glioblastoma multiforme (WHO grade IV, BRAF V-600E mutation). DISCUSSION Malignant transformation of LGGs in children is a very rare phenomenon. This is to our knowledge the first well-documented case describing malignant transformation of a suspected benign pediatric cerebral mass lesion, which did not undergo radiation, in a patient without a cancer predisposition syndrome (e.g., neurofibromatosis), with the transformation occurring after such a long follow-up period. The management of these lesions is still controversial. Unfortunately, radiological risk factors for malignant transformation of such lesions in the pediatric age group are lacking. CONCLUSION Conservative treatment of incidental cerebral mass lesions in children seems a valid option. These lesions should probably be followed indefinitely, while carefully watching for changes in imaging characteristics.
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Affiliation(s)
- Jehuda Soleman
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children's Hospital, 6 Weizmann Street, Tel Aviv, Israel
| | - Jonathan Roth
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children's Hospital, 6 Weizmann Street, Tel Aviv, Israel
- Tel-Aviv University, Tel Aviv, Israel
| | - Zvi Ram
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children's Hospital, 6 Weizmann Street, Tel Aviv, Israel
- Tel-Aviv University, Tel Aviv, Israel
| | - Michal Yalon
- Tel-Aviv University, Tel Aviv, Israel
- Department of Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomi Constantini
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children's Hospital, 6 Weizmann Street, Tel Aviv, Israel.
- Tel-Aviv University, Tel Aviv, Israel.
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Yokoya S, Hasegawa T, Ozono K, Tanaka H, Kanzaki S, Tanaka T, Chihara K, Jia N, Child CJ, Ihara K, Funai J, Iwamoto N, Seino Y. Incidence of diabetes mellitus and neoplasia in Japanese short-statured children treated with growth hormone in the Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS). Clin Pediatr Endocrinol 2017; 26:229-241. [PMID: 29026272 PMCID: PMC5627224 DOI: 10.1297/cpe.26.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/09/2017] [Indexed: 01/23/2023] Open
Abstract
The primary goal of the Genetics and Neuroendocrinology of Short Stature International
Study (GeNeSIS) was to assess the safety and effectiveness of Humatrope®, a GH
preparation, in the treatment of pediatric patients with short stature. We report our
findings in the GH-treated Japanese pediatric population focusing on the incidence of type
2 diabetes (T2D) and occurrence of neoplasms. A total of 2,345 Japanese patients were
assessed for safety. During a mean observation period of 3.2 yr, T2D occurred in 3
patients (0.13%) and slowly progressive insulin-dependent diabetes mellitus (SPIDDM)
related to underlying mitochondrial encephalomyopathy, lactic acidosis, and stroke-like
episodes (MELAS) in 1 patient (0.04%). Neoplasms were reported in 13 patients (0.56%),
including 1 patient with brain tumor (germinoma) and 5 with craniopharyngiomas (4
recurrences); the remainder were benign, typically dermatological, neoplasms. The
incidence of diabetes mellitus determined in the study did not differ from previous
reports in GH-treated pediatric patients, and there was no apparent increase in the risk
of new neoplastic lesions or malignant tumors.
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Affiliation(s)
- Susumu Yokoya
- Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Pediatrics, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Susumu Kanzaki
- Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Tottori, Japan
| | | | - Kazuo Chihara
- Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Nan Jia
- Lilly Research Laboratories, Eli Lilly and Company, Indiana, USA
| | | | | | - Jumpei Funai
- Scientific Communications, Eli Lilly Japan K.K., Kobe, Japan
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Alotaibi NM, Noormohamed N, Cote DJ, Alharthi S, Doucette J, Zaidi HA, Mekary RA, Smith TR. Physiologic Growth Hormone-Replacement Therapy and Craniopharyngioma Recurrence in Pediatric Patients: A Meta-Analysis. World Neurosurg 2017; 109:487-496.e1. [PMID: 28987837 DOI: 10.1016/j.wneu.2017.09.164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis were conducted to examine the effect of growth hormone-replacement therapy (GHRT) on the recurrence of craniopharyngioma in children. METHODS PubMed, Embase, and Cochrane databases were searched through April 2017 for studies that evaluated the effect of GHRT on the recurrence of pediatric craniopharyngioma. Pooled effect estimates were calculated with fixed- and random-effects models. RESULTS Ten studies (n = 3487 patients) met all inclusion criteria, including 2 retrospective cohorts and 8 case series. Overall, 3436 pediatric patients were treated with GHRT after surgery and 51 were not. Using the fixed effect model, we found that the overall craniopharyngioma recurrence rate was lower among children who were treated by GHRT (10.9%; 95% confidence interval 9.80%-12.1%; I2 = 89.1%; P for heterogeneity <0.01; n = 10 groups) compared with those who were not (35.2%; 95% confidence interval 23.1%-49.6%; I2 = 61.7%; P for heterogeneity = 0.11; n = 3); the P value comparing the 2 groups was <0.01. Among patients who were treated with GHRT, subgroup analysis revealed that there was a greater prevalence of craniopharyngioma recurrence among studies conducted outside the United States (P < 0.01), single-center studies (P < 0.01), lower impact factor studies (P = 0.03), or studies with a lower quality rating (P = 0.01). Using the random-effects model, we found that the results were not materially different except for when stratifying by GHRT, impact factor, or study quality; this led to nonsignificant differences. Both Begg's rank correlation test (P = 0.7) and Egger's linear regression test (P = 0.06) indicated no publication bias. CONCLUSIONS This meta-analysis demonstrated a lower recurrence rate of craniopharyngioma among children treated with GHRT than those who were not.
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Affiliation(s)
- Nawaf M Alotaibi
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Nadia Noormohamed
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - David J Cote
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA.
| | - Salman Alharthi
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Hasan A Zaidi
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA; Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA
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Kandaz M, Ertekin MV, Karslıoğlu İ, Erdoğan F, Sezen O, Gepdiremen A, Gündoğdu C. Zinc Sulfate and/or Growth Hormone Administration for the Prevention of Radiation-Induced Dermatitis: a Placebo-Controlled Rat Model Study. Biol Trace Elem Res 2017; 179:110-116. [PMID: 28168533 DOI: 10.1007/s12011-017-0952-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/24/2017] [Indexed: 12/21/2022]
Abstract
Growth hormone (GH) and zinc (Zn) were evaluated for their potential to prevent radiation injury using a rat model of radiation-induced skin injury. Sprague-Dawley rats were divided into five groups: a control group not receiving Zn, GH, or irradiation: a radiation (RT) group receiving a single 30 Gy dose of gamma irradiation to the right hind legs; a radiation + GH group (RT + GH) receiving a single 30 Gy dose of gamma irradiation plus the subcutaneous administration of 0.01 IU kg d-1 GH; a radiation + Zn group (RT + Zn) receiving a single 30 Gy dose plus 5 mg kg d-1 Zn po; and a radiation + GH + Zn group (RT + GH + Zn) group receiving a single 30 Gy dose plus subcutaneous 0.01 IU kg d-1 GH and 5 mg kg d-1 Zn po. Acute skin reactions were assessed every 3 days by two radiation oncologists grouping. Light microscopic findings were assessed blindly by two pathologists. Groups receiving irradiation were associated with dermatitis as compared to the control group (P < 0.05). The severity of radiodermatitis in the RT + GH, RT + Zn, and RT + GH + Zn groups was significantly lower than that in the RT group (P < 0.05). Furthermore, radiodermatitis was observed earlier in the RT group than in the other treatment groups (P < 0.05). GH and Zn effectively prevented epidermal atrophy, dermal degeneration, and hair follicle atrophy. The highest level of protection against radiation dermatitis was observed in the combination group.
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Affiliation(s)
- Mustafa Kandaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, 61100, Trabzon, Turkey.
| | - Mustafa Vecdi Ertekin
- Department of Radiation Oncology, Avrasya Hospital, Beştelsiz Mah., 101., Sok., No:107, Akşemsettin Tramvay Durağı, Zeytinburnu, 34020, Istanbul, Turkey
| | - İhsan Karslıoğlu
- Department of Radiation Oncology, Medikal Park Hospital, Olgunlar Mahallesi, Atatürk Bulvarı, No:5, 23040, Elazığ, Turkey
| | - Fazlı Erdoğan
- Department of Pathology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Orhan Sezen
- Department of Radiation Oncology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Akçahan Gepdiremen
- Department of Pharmacology, Faculty of Medicine, Abant İzzet Baysal University, Gölköy Yerleşkesi, 14300, Bolu, Turkey
| | - Cemal Gündoğdu
- Department of Pathology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Ding Q, Wang Z, Shen M, Su Z, Shen L. Acute Alcohol Exposure and Risk of Mortality of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Alcohol Clin Exp Res 2017; 41:1532-1540. [PMID: 28654159 DOI: 10.1111/acer.13436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/02/2017] [Indexed: 01/08/2023]
Abstract
After traumatic brain injury (TBI), patients usually live with significant disability and socioeconomic burdens. Acute exposure to alcohol is considered a major risk factor for TBI. Numerous studies have examined whether alcohol exposure is related to the risk of mortality in patients with TBI, yet the results remain inconsistent. We performed a meta-analysis to assess whether acute alcohol exposure affects the mortality rate of TBI patients. We searched PubMed, EMBASE, and the Cochrane Library up to November 2015 for relevant studies. We screened studies based on their inclusion criteria and selected the studies that reported mortality rate, which included 18 observational studies. We used R to analyze the included data. An initial result showed that the presence of a positive blood alcohol concentration (BAC) had no significant relation with mortality rate (OR = 0.92, 95% CI = 0.83 to 1.01), but there was notable heterogeneity along with variable results according to sensitivity analysis. For the BAC-positive population, low BAC (1 to 100 mg/dl) carried a higher risk of mortality than moderate BAC (100 to 230 mg/dl) (OR = 1.40, 95% CI = 1.09 to 1.81), moderate and high BAC as a single category (>100 mg/dl) (OR = 1.57, 95% CI = 1.28 to 1.94), or high BAC (>230 mg/dl) (OR = 1.76, 95% CI = 1.34 to 2.30). However, moderate BAC did not increase the mortality risk when compared with high BAC (OR = 1.20, 95% CI = 0.89 to 1.63). Whether positive BAC at the time of admission after TBI reduces mortality rate compared with the rate under negative BAC remains unknown. In addition, low BAC (1 to 100 mg/dl) poses a risk of mortality compared with higher BAC. Further studies assessing the effect of alcohol between the BAC-positive group and the BAC-negative group are still needed.
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Affiliation(s)
- Qiuping Ding
- Department of General Surgery, Huzhou Central Hospital, Huzhou, China
| | - Zhuo Wang
- School of Nursing, Soochow University, Suzhou, China
| | - Meifen Shen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, China
| | - Liang Shen
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, China
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Gasco V, Caputo M, Lanfranco F, Ghigo E, Grottoli S. Management of GH treatment in adult GH deficiency. Best Pract Res Clin Endocrinol Metab 2017; 31:13-24. [PMID: 28477728 DOI: 10.1016/j.beem.2017.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Growth hormone (GH) replacement therapy in adults with GH deficiency is still a challenge for the clinical endocrinologist and its implementation has still numerous difficulties and uncertainties. The decision to treat GH deficient adults requires a thoughtful and individualized evaluation of risks and benefits. Benefits have been found in body composition, bone health, cardiovascular risk factors, and quality of life. However, evidences for a reduction in cardiovascular events and mortality are still lacking, and treatment costs remain high. It is advisable to start treatment with low doses of GH, the goals being an appropriate clinical response, an avoidance of side effects, and IGF-I levels in the age-adjusted reference range. Although treatment appears to be overall safe, certain areas continue to require long-term surveillance, such as risks of glucose intolerance, pituitary/hypothalamic tumor recurrence, and cancer.
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Affiliation(s)
- Valentina Gasco
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy.
| | - Marina Caputo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - Fabio Lanfranco
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - Silvia Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
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28
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Long-term safety of growth hormone replacement therapy after childhood medulloblastoma and PNET: it is time to set aside old concerns. J Neurooncol 2016; 131:349-357. [DOI: 10.1007/s11060-016-2306-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/18/2016] [Indexed: 01/11/2023]
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Growth Hormone Protects the Intestine Preserving Radiotherapy Efficacy on Tumors: A Short-Term Study. PLoS One 2015; 10:e0144537. [PMID: 26670463 PMCID: PMC4682900 DOI: 10.1371/journal.pone.0144537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
The efficacy of radiotherapy on tumors is hampered by its devastating adverse effects on healthy tissue, particularly that of the gastrointestinal tract. These effects cause acute symptoms that are so disruptive to patients that they can lead to interruption of the radiotherapy program. These adverse effects could limit the intensity of radiation received by the patient, resulting in a sublethal dose to the tumor, thus increasing the risk of tumor resistance. The lack of an effective treatment to protect the bowel during radiation therapy to allow higher radiation doses that are lethal to the tumor has become a barrier to implementing effective therapy. In this study, we present a comparative analysis of both intestinal and tumor tissue in regard to the efficacy and the preventive impact of a short-term growth hormone (GH) treatment in tumor-bearing rats as a protective agent during radiotherapy. Our data show that the exogenous administration of GH improved intestinal recovery after radiation treatment while preserving the therapeutic effect against the tumor. GH significantly increased proliferation in the irradiated intestine but not in the irradiated tumors, as assessed by Positron Emission Tomography and the proliferative markers Ki67, cyclin D3, and Proliferating Cell Nuclear Antigen. This proliferative effect was consistent with a significant increase in irradiated intestinal villi and crypt length. Furthermore, GH significantly decreased caspase-3 activity in the intestine, whereas GH did not produce this effect in the irradiated tumors. In conclusion, short-term GH treatment protects the bowel, inducing proliferation while reducing apoptosis in healthy intestinal tissue and preserving radiotherapy efficacy on tumors.
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Prognostic factors of craniopharyngioma with special reference to autocrine/paracrine signaling: underestimated implication of growth hormone receptor. Acta Neurochir (Wien) 2015; 157:1731-40. [PMID: 26246149 DOI: 10.1007/s00701-015-2519-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Craniopharyngioma is a slow-growing tumor classified as benign, but tight adhesion and significant local infiltration to the vital structures are common. In spite of improvement of modern microsurgery techniques and precise anatomical understanding not few cases of this tumor recur, and long-term tumor control and maintenance of quality of life are sometimes difficult. However, very little is known about the effects of the molecular characters of craniopharyngioma on the prognosis. METHODS Ninety eight cases of craniopharyngioma surgically treated at the Department of Neurosurgery, Tohoku University Hospital and Kohnan Hospital from April 1996 to May 2014, 45 males and 53 females aged from 2 to 80 years (mean, 40.84 years) were retrospectively reviewed, and postoperative outcomes and the possible involvement of the autocrine/paracrine mechanism were investigated. The patients were followed up at intervals of 6 months to assess tumor recurrence, and clinical outcomes were correlated with the findings of immunohistochemical examinations used growth hormone receptor (GHR) and downstream hormones. The follow-up period ranged from 3 to 209 months. RESULTS Hormone expression was examined in 88 patients, of which 46 specimens (52.3 %) showed high expression of GHR. The GHR high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.007). Simultaneous high expression of growth hormone (GH) and GHR was found in 33 specimens (37.5 %), and the high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.011). No other hormones showed statistically significant differences in outcomes. CONCLUSIONS High expression of GHR is associated with shorter duration of postoperative stable disease in patients with craniopharyngioma. If the surgical specimens were craniopharyngiomas with high GHR expression, GH supplementation would be introduced quite prudently.
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