Endocrine Abstracts

Background/objective: Published data suggest that growth hormone replacement (GHR) may be safely given to patients with hypopituitarism consequent upon a pituitary/peri-pituitary tumour. However, to date, these series have included a preponderance of patients treated with external pituitary irradiation. We have performed a retrospective study to evaluate the recurrence rate in a group of patients with pituitary/peripituitary tumours treated with GHR.

Methods: Pituitary surveillance imaging was performed at baseline (prior to GHR), at 6–12 months and then again yearly or as clinically indicated. For patients with secretory tumours, biochemical markers (cortisol and prolactin) were used as evidence of tumour recurrence. All scans were reviewed by a single neuroradiologist.

Results: 48 patients were studied. The primary diagnoses were: Cushing’s disease (14), craniopharyngioma (9; six childhood/adolescent onset), functionless adenoma (8), prolactinoma (7), pituitary cysts (5) including two arachnoid, two Rathke’s cysts and one cystic chromophobe adenoma, acromegaly (4) and meningioma (1). Median follow up was 38 months (range 9–104). Three patients were judged to have an apparent increase in tumour volume. One had an arachnoid cyst which re-accumulated during GHR requiring transsphenoidal redrainage for symptomatic visual disturbance, subsequent 12 month scan remains stable. The second had a partially resistant macroprolactinoma associated with a rise in prolactin from 104 miu/L to 642 miu/L and a slight increase in tumour volume; both were reversed by an increase in carbergoline dose. In both patients these changes in volume and biochemical markers were evident prior to GHR and continued on replacement. The third patient with cystic chromophobe adenoma resected 49 years ago, had a marginal increase in residual tumour volume four years after GH commencement she is under surveillance with no interruption to her GHR.

Conclusion: The use of GHR in patients with pituitary mass lesion who have not undergone radiotherapy appears safe.