Buchfelder Michael, Kann Peter Herbert, Wüster Christian, Tuschy Ulrich, Saller Bernhard, Brabant Georg, Kleindienst Andrea, Nomikos Panagiotis
Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
Eur J Endocrinol. 2007 Aug;157(2):149-56. doi: 10.1530/EJE-07-0164.
Several studies documented metabolic and psychological benefits of GH substitution in deficient adults, most of them suffering from benign pituitary adenomas. Since GH substitution is considered to promote tumour regrowth, adequate treatment is performed with some reservation. Therefore, we aimed to elucidate the effect of GH replacement therapy on tumour recurrence following surgery.
In patients with hormonally inactive pituitary adenomas undergoing tumour surgery, a retrospective case-control study was performed. Pre- and postoperative magnetic resonance (MR) images of GH-treated and untreated patients were matched for best fit by two independent observers. The treated patients were retrieved from the surveillance programme of the German KIMS database and the untreated from the database of the Department of Neurosurgery, University of Erlangen. A total of 55 matched pairs were followed for at least 5 years. Tumour recurrence and progression rates were determined according to the postoperative MR.
There were 16 tumour progressions in the treatment group and 12 in the control group. Statistical analysis revealed no significant increase in either recurrence (P = 0.317) or progression (P = 0.617) within the follow-up period of 5 years when GH was adequately replaced.
This study provides further observational data of substitution therapy in GH-deficient adults with pituitary adenomas. Comparing long-term surgical results, we found no evidence that GH substitution should be withheld in deficient patients. Even residual tumour does not constitute a contraindication to GH replacement. However, since pituitary tumours are slow growing, an observational period of 5 years may not have been long enough to verify any absolute influence on recurrence potential.
多项研究记录了生长激素替代疗法对成年生长激素缺乏患者的代谢和心理益处，其中大多数患者患有良性垂体腺瘤。由于生长激素替代疗法被认为会促进肿瘤复发，因此在进行充分治疗时会有所保留。因此，我们旨在阐明生长激素替代疗法对手术后肿瘤复发的影响。
对接受肿瘤手术的无功能性垂体腺瘤患者进行回顾性病例对照研究。由两名独立观察者对接受生长激素治疗和未接受治疗患者的术前和术后磁共振（MR）图像进行最佳匹配。治疗组患者从德国KIMS数据库的监测项目中选取，未治疗组患者从埃尔朗根大学神经外科数据库中选取。共55对匹配患者至少随访5年。根据术后MR确定肿瘤复发和进展率。
治疗组有16例肿瘤进展，对照组有12例。统计分析显示，在5年的随访期内，当生长激素得到充分替代时，复发（P = 0.317）或进展（P = 0.617）均无显著增加。
本研究提供了成年垂体腺瘤生长激素缺乏患者替代治疗的进一步观察数据。比较长期手术结果，我们发现没有证据表明生长激素缺乏患者应停止生长激素替代治疗。即使存在残留肿瘤也不构成生长激素替代治疗的禁忌证。然而，由于垂体肿瘤生长缓慢，5年的观察期可能不足以验证对复发潜能的任何绝对影响。
