Cardiac changes associated with growth hormone therapy among children treated with anthracyclines.
OBJECTIVE
The objective was to assess the cardiac effects of growth hormone (GH) therapy. Anthracycline-treated childhood cancer survivors frequently have reduced left ventricular (LV) wall thickness and contractility, and GH therapy may affect these factors.


METHODS
We examined serial cardiac findings for 34 anthracycline-treated childhood cancer survivors with several years of GH therapy and baseline cardiac z scores similar to those of a comparison group (86 similar cancer survivors without GH therapy).


RESULTS
LV contractility was decreased among GH-treated patients before, during, and after GH therapy (-1.08 SD below the age-adjusted population mean before therapy and -1.88 SD 4 years after therapy ceased, with each value depressed below normal). Contractility was higher in the control group than in the GH-treated group, with this difference being nearly significant. The GH-treated children had thinner LV walls before GH therapy (-1.38 SD). Wall thickness increased during GH therapy (from -1.38 SD to -1.09 SD after 3 years of GH therapy), but the effect was lost shortly after GH therapy ended and thickness diminished over time (-1.50 SD at 1 year after therapy and -1.96 SD at 4 years). During GH therapy, the wall thickness for the GH-treated group was greater than that for the control group; however, by 4 years after therapy, there was no difference between the GH-treated group and the control group.


CONCLUSIONS
GH therapy among anthracycline-treated survivors of childhood cancer increased LV wall thickness, but the effect was lost after therapy was discontinued. The therapy did not affect the progressive LV dysfunction.
Lipshultz
Steven E
SE
Department of Pediatrics, Miller School of Medicine, University of Miami, Holtz Children's Hospital, Sylvester Comprehensive Cancer Center, Miami, Florida, USA. slipshultz@med.miami.edu
Vlach
Sarah A
SA
Lipsitz
Stuart R
SR
Sallan
Stephen E
SE
Schwartz
Marcy L
ML
Colan
Steven D
SD
D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001827:Body Height; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006439:Hemodynamics; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced; D007018:Hypopituitarism / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D008297:Male; D009200:Myocardial Contraction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D017741:Survivors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D018943:Anthracyclines; D002317:Cardiovascular Agents; D019382:Human Growth Hormone; D004656:Enalapril