Mylena Maria Guedes de Almeida, Pedro Henrique Aquino Gil de Freitas, Áurea Maria Salomão Simão, Ana Beatriz Bertol, Barkhá Vijendra, Bianca Lisa de Faria
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引用次数: 0
Abstract
Purpose: Craniopharyngiomas (CPs) often lead to growth hormone deficiency (GHD) in children. Growth hormone replacement therapy (GHRT) is essential for managing GHD but its impact on body mass index (BMI) and metabolic outcomes is controversial. Concerns exist that GHRT might contribute to tumor recurrence, with guidelines varying on when to start therapy post-surgery. This updated systematic review and meta-analysis explores the effects and timing of GHRT in children post-craniopharyngioma surgery.
Methods: We systematically searched PubMed, Embase, and Cochrane Library databases. Included studies compared the effects of GHRT in childhood-onset craniopharyngioma patients who received GHRT versus those who did not. Random-effects meta-analyses were used to pool relative risk (RR) or mean difference (MD) for each outcome. Heterogeneity was assessed using the I² statistic. This study is registered with PROSPERO (CRD42024498082).
Results: We included 11 studies in the meta-analysis. No differences in tumor progression/recurrence were found between the GHRT and no GHRT groups (RR 0.77, 95% CI 0.56-1.05, p = 0.10). The impact of timing of GHRT is less clear because of limited data and high heterogeneity. There were no differences in BMI between the GHRT and no GHRT (MD -0.94, 95% CI -1.88,0.00, p = 0.05). Two studies reported that GHRT might improve lipid profiles.
Conclusion: Our study suggests that GHRT does not increase the risk of tumor progression/recurrence in CP patients. GHRT can improve linear growth, but its effects on the BMI and lipid profiles remain inconclusive, requiring further studies.
目的:颅咽管瘤(CPs)常导致儿童生长激素缺乏症(GHD)。生长激素替代疗法(GHRT)对于治疗GHD至关重要,但其对身体质量指数(BMI)和代谢结果的影响存在争议。人们担心GHRT可能会导致肿瘤复发,在手术后何时开始治疗的指导方针各不相同。这项最新的系统综述和荟萃分析探讨了GHRT在儿童颅咽管瘤术后的作用和时机。方法:系统检索PubMed、Embase和Cochrane图书馆数据库。纳入的研究比较了GHRT在儿童发病颅咽管瘤患者中接受GHRT与未接受GHRT的效果。随机效应荟萃分析用于汇总每个结果的相对风险(RR)或平均差异(MD)。采用I²统计量评估异质性。本研究已在PROSPERO注册(CRD42024498082)。结果:我们在meta分析中纳入了11项研究。GHRT组和未GHRT组在肿瘤进展/复发方面无差异(RR 0.77, 95% CI 0.56-1.05, p = 0.10)。由于数据有限且异质性高,GHRT时间的影响尚不清楚。GHRT组和未GHRT组的BMI无差异(MD -0.94, 95% CI -1.88,0.00, p = 0.05)。两项研究报告GHRT可能改善脂质谱。结论:我们的研究表明GHRT不会增加CP患者肿瘤进展/复发的风险。GHRT可以改善线性生长,但其对BMI和脂质谱的影响仍不确定,需要进一步研究。
期刊介绍:
Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease.
The journal considers:
Biology of Pituitary Tumors
Mechanisms of Pituitary Hormone Secretion
Regulation of Pituitary Function
Prospective Clinical Studies of Pituitary Disease
Critical Basic and Clinical Reviews
Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.