Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas:: a case-control study
Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas:: a case-control study
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DOI：
10.1530/eje-07-0164
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发表时间：
2007-08-01
影响因子：
5.8
通讯作者：
Nomikos, Panagiotis
中科院分区：
文献类型：
--
作者：
Buchfelder, Michael;Kann, Peter Herbert;Nomikos, Panagiotis
目的：几项研究记录了GH替代在缺乏成年人中的代谢和心理益处，其中大多数患有良性垂体腺瘤。由于GH替代被认为是促进肿瘤再生长，适当的治疗进行了一些保留。因此，我们的目的是阐明生长激素替代治疗对肿瘤复发的影响，以下surgery.Methods：在接受肿瘤手术的垂体腺瘤患者中，进行了回顾性病例对照研究。GH治疗和未治疗患者的术前和术后磁共振（MR）图像由两名独立观察者匹配以获得最佳拟合。从德国KIMS数据库的监测项目中检索治疗患者，从埃尔兰根大学神经外科系数据库中检索未治疗患者。共对55对匹配的配对进行了至少5年的随访。根据术后MR确定肿瘤复发率和进展率。结果：治疗组有16例肿瘤进展，对照组有12例肿瘤进展。统计分析显示，没有显着增加复发（P=0.317）或进展（P=0.61.7）在随访期内的5年时GH是充分replaced.Conclusions：这项研究提供了进一步的观察数据，替代治疗GH缺乏的成人垂体腺瘤。比较长期手术结果，我们发现没有证据表明生长激素替代品应在缺陷患者中保留。即使是残留的肿瘤也不构成GH替代的禁忌症。然而，由于垂体瘤生长缓慢，5年的观察期可能不足以验证任何绝对影响复发的可能性。
Objective: 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.Methods: 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.Results: 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=0.61.7) within the follow-up period of 5 years when GH was adequately replaced.Conclusions: 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 oil recurrence potential.