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. 2022 Jul 14:13:920482.
doi: 10.3389/fendo.2022.920482. eCollection 2022.

Expert Opinion on the Management of Growth Hormone Deficiency in Brain Tumor Survivors: Results From an Italian Survey

Natascia Di Iorgi  1   2 , Giovanni Morana  3 , Marco Cappa  4 , Ludovico D'Incerti  5 , Maria Luisa Garrè  6 , Armando Grossi  7 , Lorenzo Iughetti  8 , Patrizia Matarazzo  9 , Maria Parpagnoli  10 , Gabriella Pozzobon  11 , Mariacarolina Salerno  12 , Iacopo Sardi  13 , Malgorzata Gabriela Wasniewska  14 , Stefano Zucchini  15 , Andrea Rossi  16   17 , Mohamad Maghnie  1   2
Affiliations

Expert Opinion on the Management of Growth Hormone Deficiency in Brain Tumor Survivors: Results From an Italian Survey

Natascia Di Iorgi et al. Front Endocrinol (Lausanne). .

Abstract

Background: Growth hormone deficiency (GHD) is the first and most common endocrine complication in pediatric brain tumor survivors (BTS). GHD can occur due to the presence of the tumor itself, surgery, or cranial radiotherapy (CRT).

Aims: This study aimed to evaluate management and adherence to current guidelines of the Italian centers engaged in the diagnosis and follow-up of GHD patients with BTS.

Methods: A multidisciplinary scientific board of pediatric endocrinologists, oncologists and radiologists with neuroimaging expertise discussed and reviewed the main issues relating to the management of GHD in pediatric BTS and developed a survey. The survey included questions relating to organizational aspects, risk factors, diagnosis, definition of stable disease, and treatment. The online survey was sent to an expanded panel of specialists dedicated to the care of pediatric BTS, distributed among the three specialty areas and throughout the country (23 Italian cities and 37 Centers).

Results: The online questionnaire was completed by 86.5% (32 out of 37) of the Centers involved. Most had experience in treating these patients, reporting that they follow more than 50 BTS patients per year. Responses were analyzed descriptively and aggregated by physician specialty. Overall, the results of the survey showed some important controversies in real life adherence to the current guidelines, with discrepancies between endocrinologists and oncologists in the definition of risk factors, diagnostic work-up, decision-making processes and safety. Furthermore, there was no agreement on the neuroimaging definition of stable oncological disease and how to manage growth hormone therapy in patients with residual tumor and GHD.

Conclusions: The results of the first Italian national survey on the management of GHD in BTS highlighted the difference in management on some important issues. The time to start and stop rhGH treatment represent areas of major uncertainty. The definition of stable disease remains critical and represents a gap in knowledge that must be addressed within the international guidelines in order to increase height and to improve metabolic and quality of life outcomes in cancer survivors with GHD.

Keywords: brain MRI; growth hormone deficiency; pediatric brain tumor survivors; radiotherapy; recombinant human growth hormone (rhGH).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Q6: Which of these tumors do you think are more likely to cause GHD? (B) Q7: Which histological types of tumor are most likely to cause GHD?
Figure 2
Figure 2
Q8: Radiotherapy (RT) as a risk factor for GHD.
Figure 3
Figure 3
Q13: Neuroradiological definition of stable tumoral disease in BTS.
Figure 4
Figure 4
Q14: MRI sequence to define stable tumoral disease in BTS.
See this image and copyright information in PMC

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