Cancer risk following growth hormone use in childhood: implications for current practice.

2.50
Hdl Handle:
http://hdl.handle.net/10541/77999
Title:
Cancer risk following growth hormone use in childhood: implications for current practice.
Authors:
Ogilvy-Stuart, Amanda L; Gleeson, Helena K
Abstract:
The therapeutic use of growth hormone (GH) has caused concern, as it is anabolic and mitogenic, and its effector hormone, insulin-like growth factor (IGF)-I is anti-apoptotic. As both hormones can cause proliferation of normal and malignant cells, the possibility that GH therapy may induce cancer, increase the risk of tumour recurrence in those previously treated for a malignancy, or increase the risk of cancer in those with a predisposition, has resulted in concerns over its use. There are theoretical and epidemiological reasons that suggest GH and IGF-I may be important in tumour formation and proliferation. Malignant tumours have been induced in animals exposed to supraphysiological doses of GH, whereas hypophysectomy appears to protect animals from carcinogen-induced neoplasms. In vitro, proliferation and transformation of normal haemopoetic and leukaemic cells occurs with supraphysiological doses of GH, but not with physiological levels. IGF, IGF binding proteins (IGFBP) and IGFBP proteases influence the proliferation of cancer cells in vitro; however, GH is probably not involved in this process. Epidemiological studies have suggested an association between levels of IGF-I and cancer, and an inverse relationship between IGFBP-3 and cancer; however, these associations have been inconsistent. A number of studies have been undertaken to determine the risk of the development of cancer in children treated with GH, either de novo, or the recurrence of cancer in those previously treated for a malignancy. Despite early concerns following a report of a cluster of cases of leukaemia in recipients of GH, there appears to be no increased risk for the development of leukaemia in those treated with GH unless there is an underlying predisposition. Even in children with a primary diagnosis of cancer, subsequent GH use does not appear to increase the risk of tumour recurrence. However, a recent follow-up of pituitary GH recipients has suggested an increase in colorectal cancer. In addition, follow-up of oncology patients has suggested an increase in second neoplasms in those who also received GH therapy. These studies emphasise the importance of continued surveillance both internationally with established databases and also nationally through single-centre studies.
Affiliation:
Department of Paediatrics, Addenbrooke's NHS Trust, Cambridge, United Kingdom. amanda.ogilvy_stuart@addenbrookes.nhs.uk
Citation:
Cancer risk following growth hormone use in childhood: implications for current practice. 2004, 27 (6):369-82 Drug Saf
Journal:
Drug Safety
Issue Date:
2004
URI:
http://hdl.handle.net/10541/77999
PubMed ID:
15144231
Type:
Article
Language:
en
ISSN:
0114-5916
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorOgilvy-Stuart, Amanda L-
dc.contributor.authorGleeson, Helena K-
dc.date.accessioned2009-08-20T11:24:29Z-
dc.date.available2009-08-20T11:24:29Z-
dc.date.issued2004-
dc.identifier.citationCancer risk following growth hormone use in childhood: implications for current practice. 2004, 27 (6):369-82 Drug Safen
dc.identifier.issn0114-5916-
dc.identifier.pmid15144231-
dc.identifier.urihttp://hdl.handle.net/10541/77999-
dc.description.abstractThe therapeutic use of growth hormone (GH) has caused concern, as it is anabolic and mitogenic, and its effector hormone, insulin-like growth factor (IGF)-I is anti-apoptotic. As both hormones can cause proliferation of normal and malignant cells, the possibility that GH therapy may induce cancer, increase the risk of tumour recurrence in those previously treated for a malignancy, or increase the risk of cancer in those with a predisposition, has resulted in concerns over its use. There are theoretical and epidemiological reasons that suggest GH and IGF-I may be important in tumour formation and proliferation. Malignant tumours have been induced in animals exposed to supraphysiological doses of GH, whereas hypophysectomy appears to protect animals from carcinogen-induced neoplasms. In vitro, proliferation and transformation of normal haemopoetic and leukaemic cells occurs with supraphysiological doses of GH, but not with physiological levels. IGF, IGF binding proteins (IGFBP) and IGFBP proteases influence the proliferation of cancer cells in vitro; however, GH is probably not involved in this process. Epidemiological studies have suggested an association between levels of IGF-I and cancer, and an inverse relationship between IGFBP-3 and cancer; however, these associations have been inconsistent. A number of studies have been undertaken to determine the risk of the development of cancer in children treated with GH, either de novo, or the recurrence of cancer in those previously treated for a malignancy. Despite early concerns following a report of a cluster of cases of leukaemia in recipients of GH, there appears to be no increased risk for the development of leukaemia in those treated with GH unless there is an underlying predisposition. Even in children with a primary diagnosis of cancer, subsequent GH use does not appear to increase the risk of tumour recurrence. However, a recent follow-up of pituitary GH recipients has suggested an increase in colorectal cancer. In addition, follow-up of oncology patients has suggested an increase in second neoplasms in those who also received GH therapy. These studies emphasise the importance of continued surveillance both internationally with established databases and also nationally through single-centre studies.en
dc.language.isoenen
dc.subjectCanceren
dc.subjectBrain Canceren
dc.subjectCancer Recurrenceen
dc.subjectLeukaemiaen
dc.subject.meshAnimals-
dc.subject.meshBrain Neoplasms-
dc.subject.meshCell Division-
dc.subject.meshChild-
dc.subject.meshDisease Models, Animal-
dc.subject.meshGrowth Disorders-
dc.subject.meshGrowth Hormone-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.subject.meshInsulin-Like Growth Factor Binding Protein 3-
dc.subject.meshInsulin-Like Growth Factor I-
dc.subject.meshLeukemia-
dc.subject.meshNeoplasm Recurrence, Local-
dc.subject.meshNeoplasms-
dc.subject.meshRisk Factors-
dc.titleCancer risk following growth hormone use in childhood: implications for current practice.en
dc.typeArticleen
dc.contributor.departmentDepartment of Paediatrics, Addenbrooke's NHS Trust, Cambridge, United Kingdom. amanda.ogilvy_stuart@addenbrookes.nhs.uken
dc.identifier.journalDrug Safetyen

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