Cardiac changes associated with growth hormone therapy among children treated with anthracyclines

Pediatrics. 2005 Jun;115(6):1613-22. doi: 10.1542/peds.2004-1004.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anthracyclines / administration & dosage
  • Anthracyclines / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Body Height
  • Cardiovascular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Enalapril / therapeutic use
  • Female
  • Heart Ventricles / pathology
  • Hemodynamics
  • Human Growth Hormone / therapeutic use*
  • Humans
  • Hypertrophy, Left Ventricular / chemically induced
  • Hypopituitarism / chemically induced
  • Hypopituitarism / drug therapy
  • Hypopituitarism / etiology
  • Infant
  • Male
  • Myocardial Contraction
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Survivors
  • Ultrasonography
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / drug therapy

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Anthracyclines
  • Cardiovascular Agents
  • Human Growth Hormone
  • Enalapril