Endocrine Abstracts

The potential for primary tumour relapse is an important consideration during GH replacement therapy (GHR). We report 3 cases of relapse of intra cranial germ cell tumour (GCT) during GHR.

Patient 1: An 11 year-old female presenting with visual loss and short stature due to a suprasellar malignant teratoma. She was successfully treated with bleomycin, etoposide and cisplatinum (BEP) and intrathecal chemotherapy. She suffered a first relapse two years later, further treated with BEP and radiotherapy to the tumour site. Her growth velocity improved on GHR after initial presentation; this was maintained and she was followed with MRI surveillance. A second relapse occurred 7 years later. Following further platinum-based chemotherapy, she remains well aged 30 years.

Patient 2: A 50 year-old male presenting with headache and panhypopituitarism. A dicentric suprasellar and pineal GCT was evident on MRI and PET scans, and responded well to combined platinum-based chemotherapy and cranio-spinal radiotherapy. Three years later he was commenced on GHR for 19 months at which stage his disease relapsed. Response to further chemotherapy was limited and he succumbed to aggressive disease.

Patient 3: A 13 year-old male, presenting to another institution with diabetes insipidus, due to a presumed suprasellar GCT associated with an elevated beta-HCG concentration in CSF. After initial treatment with BEP, he suffered his first relapse five years later and responded well to combined platinum-based chemotherapy and radiotherapy to the primary lesion. Following neurological symptoms, MRI, detected recurrence of disease nine years after GHR. He is currently undergoing salvage chemotherapy treatment.

Against a background of previously reported safety of GHR in treated pituitary and peripituitary tumours, these cases reflect a high recurrence rate of GCT. The safety of GHR in treated GCT remains uncertain and warrants further multicentre study.