Cooper Odelia, Kim Sungjin
Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, 90048 USA.
Biostatistics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Endocr Soc. 2025 Apr 28;9(6):bvaf072. doi: 10.1210/jendso/bvaf072. eCollection 2025 Jun.
Patients with adult-onset craniopharyngioma (CP) show metabolic dysfunction and panhypopituitarism. Growth hormone (GH) deficiency is often left unaddressed despite the benefits of GH replacement on body composition and lipoprotein metabolism in the general population.
The aim was to analyze data from Hypopituitary Control and Complications Study (HypoCCS), a global prospective surveillance study of adult GH replacement, and assess the impact of GH replacement on metabolic outcomes in adult-onset CP.
Primary outcome was a composite endpoint of adverse hepatic outcomes including metabolic dysfunction-associated steatotic liver disease; secondary outcomes included body composition, lipids, blood pressure, glycemic measures, mortality, bone density, and cardiovascular endpoints.
In total, 592 patients with adult-onset CP were identified; 544 received GH for a median of 4.03 years (IQR 2.28-7.82). The 3972 patients with pituitary adenoma (3346 receiving GH) were analyzed for context. GH replacement did not impact hepatic outcomes in either cohort. In adult-onset CP, bone mineral content was significantly lower with GH replacement (estimated mean [est]: 324.90 g; 95% CI -574.49, -75.31; = .034); lower waist-hip ratio and less dyslipidemia medication use were also seen. In pituitary adenomas, fasting blood glucose (est 6.45; 95% CI 3.24, 9.66; < .001), diastolic blood pressure (est 1.44; 95% CI 0.45, 2.43; = .005), and mean arterial pressure (est 1.20; 95% CI 0.14, 2.26; = .027) were significantly higher.
GH led to decreased waist-hip ratio and lipid medication use but adversely impacted bone mineral content in adult-onset CP. Prospective studies of GH replacement in adult-onset CP can further define the benefits on metabolic outcomes in these patients.
成年起病的颅咽管瘤（CP）患者存在代谢功能障碍和全垂体功能减退。尽管生长激素（GH）替代疗法对一般人群的身体成分和脂蛋白代谢有益，但生长激素缺乏往往未得到治疗。
分析垂体功能减退控制与并发症研究（HypoCCS）的数据，这是一项关于成人生长激素替代疗法的全球前瞻性监测研究，并评估生长激素替代疗法对成年起病的颅咽管瘤患者代谢结局的影响。
主要结局是包括代谢功能障碍相关脂肪性肝病在内的不良肝脏结局的复合终点；次要结局包括身体成分、血脂、血压、血糖指标、死亡率、骨密度和心血管终点。
共确定了592例成年起病的颅咽管瘤患者；544例接受生长激素治疗，中位治疗时间为4.03年（四分位间距2.28 - 7.82）。对3972例垂体腺瘤患者（3346例接受生长激素治疗）进行了背景分析。生长激素替代疗法对两个队列的肝脏结局均无影响。在成年起病的颅咽管瘤患者中，生长激素替代疗法使骨矿物质含量显著降低（估计均值[est]：324.90g；95%置信区间-574.49，-75.31；P = 0.034）；还观察到腰臀比降低和血脂异常药物使用减少。在垂体腺瘤患者中，空腹血糖（est 6.45；95%置信区间3.24，9.66；P < 0.001）、舒张压（est 1.44；95%置信区间0.45，2.43；P = 0.005）和平均动脉压（est 1.20；95%置信区间0.14，2.26；P = 0.027）显著升高。
生长激素导致成年起病的颅咽管瘤患者腰臀比降低和血脂药物使用减少，但对骨矿物质含量有不利影响。对成年起病的颅咽管瘤患者生长激素替代疗法的前瞻性研究可以进一步明确对这些患者代谢结局的益处。
