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

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Abstract

Purpose

Growth hormone deficiency (GHD) is the most prevalent hypothalamic–pituitary (HP) disorder found in childhood cancer survivors (CCS). The published studies assessing GHD in CCS concluded that recombinant human GH (rhGH) does not restore final height (FH) to that predicted from mid-parental height (MPH). Thus, wider analyses on final height outcomes after rhGH in CCS are needed.

Methods

Retrospective study on final height (FH) in 87 CCS treated with rhGH. Patients were divided into: Group A (n =48) who underwent cranial radiotherapy or had non-irradiated tumours of HP area, and B (n =39) who were treated with craniospinal or total body irradiation (TBI). 19/87 patients with central precocious/early puberty also received GnRH analogues.

Results

Height (HT) gain after 1 and 2 years of rhGH was 0.38 ± 0.35 SDS and 0.18 ± 0.30 SDS, respectively (P < 0.0001); mean FH was in the normal range (− 0.85 ± 1.34 SDS), though not significantly different from HT SDS at baseline. 67% overall failed to reach MPH especially in Group B (P < 0.0001). However, height loss (HT SDS-MPH SDS) at FH improved or remained stable compared to baseline in 26/45 patients (58%). On stepwise regression analysis, major determinants of FH were HT at baseline (P < 0.0001) and delay before start of rhGH (P = 0.012). There was no significant difference in FH when GnRHa was added to rhGH.

Conclusion

rhGH and GnRH analogues therapy, when indicated, though failing to induce catch-up growth, prevented further height loss leading to a FH within the normal range but still below MPH, this latter being statistically significant in children who received craniospinal and TBI.

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Acknowledgements

We would like to acknowledge Dr. Murray Bain for reviewing the manuscript and Prof. Maura Arosio for her suggestions.

Funding

The research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK

    G. Rodari, A. Cattoni & A. Albanese

  2. Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 28, 20122, Milan, Italy

    G. Rodari

  3. Paediatric Department, Azienda Ospedaliera San Gerardo, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy

    A. Cattoni

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  1. G. Rodari
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Correspondence to G. Rodari.

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The authors have no conflicts of interest to disclose.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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When possible, due to the retrospective design of the study, parental written informed consent was obtained from parents.

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Rodari, G., Cattoni, A. & Albanese, A. Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy. J Endocrinol Invest 43, 209–217 (2020). https://doi.org/10.1007/s40618-019-01102-w

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  • DOI: https://doi.org/10.1007/s40618-019-01102-w

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