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Cited by 117Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsChildhood Cancer Survivors' Quality of Life

Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement

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Boguszewski, Margaret C S, Boguszewski, Cesar L, Chemaitilly, Wassim, Cohen, Laurie E, Gebauer, Judith, Higham, Claire, Hoffman, Andrew R, Polak, Michel +39 more·2022·European Journal of Endocrinology
DOI 10.1530/eje-21-1186PMC PMC9066587
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Abstract

Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.

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  • Recent guidelines suggest initiation of GH as early as 3 months post completion of therapy in individuals with craniopharyngioma.

    “suggesting initiation as early as 3 months post completion of therapy in individuals with craniopharyngioma.”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [29]

    The section on timing GH therapy after tumour treatment says initiation as early as 3 months is reasonable for some children with craniopharyngioma. The claim extends that timing to individuals generally, but the consensus limits it to children with radiologically stable disease and relevant growth or metabolic concerns; it discusses adults separately. No page number is provided in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Ongoing accumulating evidence supports the safety of GH replacement.

    “Ongoing accumulating evidence of the safety of GH replacement has led to more recent guidelines (29) and other reviews (30)”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [29]

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Cited by

Sorted by citations

Authors
Boguszewski, M. C. S., Boguszewski, C. L., Chemaitilly, W., Cohen, L. E., Gebauer, J., Higham, C., Hoffman, A. R., Polak, M., Yuen, K. C. J., Alos, N., Antal, Z., Bidlingmaier, M., Biller, B. M. K., Brabant, G., Choong, C. S. Y., Cianfarani, S., Clayton, P. E., Coutant, R., Cardoso-Demartini, A. A., Fernandez, A., Grimberg, A., Guðmundsson, K., Guevara-Aguirre, J., Ho, K. K. Y., Horikawa, R., Isidori, A. M., Jørgensen, J. O. L., Kamenicky, P., Karavitaki, N., Kopchick, J. J., Lodish, M., Luo, X., McCormack, A. I., Meacham, L., Melmed, S., Mostoufi Moab, S., Müller, H. L., Neggers, S. J. C. M. M., Aguiar Oliveira, M. H., Ozono, K., Pennisi, P. A., Popovic, V., Radovick, S., Savendahl, L., Touraine, P., van Santen, H. M., & Johannsson, G.
Affiliations
  • Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
  • SEMPR (Endocrine Division), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil
  • University of Pittsburgh (US)
  • Albert Einstein College of Medicine (US)
  • University Hospital Schleswig-Holstein (DE)
  • Manchester Academic Health Science Centre (GB)
  • Stanford Medicine (US)
  • Hôpital Necker-Enfants Malades (FR)
  • Barrow Neurological Institute (US)
  • Centre Hospitalier Universitaire Sainte-Justine (CA)
  • Memorial Sloan Kettering Cancer Center (US)
  • LMU Klinikum (DE)
  • Neuroendocrine & Pituitary Tumor Clinical Center, Massachusetts General Hospital, Boston, Massachusetts, USA
  • University of Manchester (GB)
  • The University of Western Australia (AU)
  • University of Rome Tor Vergata (IT)
  • Centre Hospitalier Universitaire d'Angers (FR)
  • Pediatric Endocrinology Unit, Department of Pediatrics, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
  • Endocrinology Department, Hospital Universitario de Mostoles, Mostoles, Spain
  • Children's Hospital of Philadelphia (US)
  • National University Hospital of Iceland (IS)
  • Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito at Quito, Quito, Ecuador
  • Garvan Institute of Medical Research (AU)
  • National Center For Child Health and Development (JP)
  • Sapienza University of Rome (IT)
  • Aarhus University Hospital (DK)
  • Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France
  • University Hospitals Birmingham NHS Foundation Trust (GB)
  • Ohio University (US)
  • University of California, San Francisco (US)
  • Tongji Hospital (CN)
  • Emory University (US)
  • Cedars-Sinai Medical Center (US)
  • Divisions of Oncology and Endocrinology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  • Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzki University Oldenburg, Oldenburg, Germany
  • Erasmus MC (NL)
  • Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
  • The University of Osaka (JP)
  • Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
  • University of Belgrade (RS)
  • Rutgers, The State University of New Jersey (US)
  • Karolinska University Hospital (SE)
  • Sorbonne Université (FR)
  • Department of Pediatric Endocrinology, Wilhelmina Chilrdren’s Hospital, University Medical Center and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
  • Sahlgrenska University Hospital (SE)
Corresponding author
Karavitaki, Niki
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2022-06-01
Volume
186
Issue
6
Pages
P35-P52
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-21-1186
PMC
PMC9066587
OpenAlex
W4224305024
Cited by
117
References
8
Citations by year
2026: 18 · 2025: 32 · 2024: 29 · 2023: 27 · 2022: 11
FWCI
18.35
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Endocrinology (publishedVersion, cc-by)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (acceptedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, cc-by)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • HAL (submittedVersion)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion, cc-by)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Opin vísindi (Opin vísindi) (submittedVersion, other-oa)
Funders
  • Eli Lilly and Company
  • Pfizer
  • Sanofi
  • Massachusetts General Hospital
  • European Society of Endocrinology
  • Amryt Pharma
  • Agence Nationale de la Recherche
  • Novo Nordisk
  • Deutsche Kinderkrebsstiftung
  • Ipsen
  • National Cancer Institute (P30CA008748)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Keywords
growth hormone replacement therapy, cancer survivors, intracranial tumors, pituitary tumors, craniopharyngioma, cancer risk, carcinogenesis, insulin-like growth factor I, cancer predisposition syndromes, mortality, risk-benefit assessment

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