title: Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy.
abstract: BACKGROUND
  GH replacement therapy (GH-RT) is a widely accepted treatment in GH-deficient adults with nonfunctioning pituitary adenoma (NFPAs). However, some concerns have been raised about the safety of GH-RT because of its potentially stimulating effect on tumor growth.
  
  
  OBJECTIVE
  The aim of this study was to evaluate tumor progression in NFPA patients using GH-RT.
  
  
  METHODS
  From the Dutch National Registry of Growth Hormone Treatment in Adults, a nationwide surveillance study in severely GH-deficient adults (1998-2009), all NFPA patients with ≥ 30 days of GH-RT were selected (n = 783). Data were retrospectively collected from the start of GH-RT in adulthood (baseline).
  
  
  METHODS
  Tumor progression, including tumor recurrence after complete remission at baseline and regrowth of residual tumor.
  
  
  RESULTS
  Tumor progression developed in 12.1% of the patients after a median (range) time of 2.2 (0.1-14.9) years. Prior radiotherapy decreased tumor progression risk compared to no radiotherapy (hazard ratio = 0.16; 95% confidence interval, 0.09-0.26). Analysis in 577 patients with available baseline imaging data showed that residual tumor at baseline increased tumor progression risk compared to no residual tumor (hazard ratio = 4.5; 95% confidence interval, 2.4-8.2).
  
  
  CONCLUSIONS
  The findings in this large study were in line with those reported in literature and provide further evidence that GH-RT does not appear to increase tumor progression risk in NFPA patients. Although only long-term randomized controlled trials will be able to draw firm conclusions, our data support the current view that GH-RT is safe in NFPA patients.
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: van Varsseveld
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: van Bunderen
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: A A M
authors.initials: AA
authors.lastname: Franken
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: H P F
authors.initials: HP
authors.lastname: Koppeschaar
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
authors.affiliation: Department of Internal Medicine (N.C.v.V., C.C.v.B., M.L.D.), Endocrine Section, Neuroscience Campus Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (A.A.M.F.), Isala Clinics, 8000 GK Zwolle, The Netherlands; Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research (H.P.F.K.), 1311 RL Almere, The Netherlands; and Division of Endocrinology and Metabolism (A.J.v.d.L.), Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Drent
mesh_terms: D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D049109:Cell Proliferation / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced / Q000453:epidemiology*; D018365:Neoplasm, Residual; D009426:Netherlands / Q000453:epidemiology; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D019382:Human Growth Hormone