The efficacy and safety of rhGH replacement therapy for children and adolescents with GHD after craniopharyngioma surgery：a preliminary observation / 中华内分泌代谢杂志

ABSTRACT

Objective To observe the efficacy and safety of recombinant human growth hormone ( rhGH) replacement therapy in GHD childhood with craniopharyngioma after surgery. Methods This study retrospectively reviewed the records of 18 inpatients with secondary GHD diagnosed by insulin tolerance test ( ITT ) after craniopharyngioma surgery at the Department of Endocrinology, Beijing Tiantan Hospital, from January 2012 to December 2015. The clinical benefits and risks of 18 patients were evaluated systematically, and then were divided into rhGH treatment group(n=9) and control group(n=9). The parameters of height, growth velocity(GV), height standard deviation score (HtSDS), insulin-like growth factors-1 (IGF-Ⅰ), insulin-like growth factor binding protein 3 (IGFBP3) and adverse events rate were recorded after treatment for six months. MRI was followed up every 3 to 6 months to observe the difference of the tumor recurrence and second malignant neoplasm between two groups. Results All 18 patients with craniopharyngioma presented with multiple pituitary-target glands hormone deficiency after surgery. Among these patients, 17 cases (95% ) presented with hypothyroidism or adrenal insufficiency, 7 cases (39% ) with delayed puberty, and 12 cases(67% ) with central diabetes insipidus. Based on pituitary-target gland axis function deficiency, these patients were given appropriate L-thyroxine, prednisone, and desmopressin(DDAVP) replacement therapy, respectively. The median time of 9 patients starting rhGH replacement was 48(36,72)months after surgery. The levels of height, GV, IGF-Ⅰ, HtSDS, and IGFBP3 were significant increased after rhGH treatment for 6 months as compared with pre-treatment and control group (all P 0. 05 ). The tumor recurrence and second malignant neoplasm were not detected by MRI scanning in rhGH treatment group,but there were 3 cases in the control group. Conclusion Multiple pituitary-target glands axis deficiencies were observed in childhood patients with craniopharyngioma after neurosurgery, and the evident deficiency of GH-IGF-Ⅰ axis was observed. rhGH replacement therapy in short-term would significantly improve the parameters of growth and development of patients with GHD after craniopharyngioma neurosurgery. No recurrence tumor in situ and second malignant neoplasms were detected during the period of rhGH replacement therapy.