ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This single-center, prospective study used brain MRI to assess the prevalence of cerebrovascular abnormalities in a large cohort of adult patients born SGA and treated with GH during childhood, 12 years after rhGH treatment cessation. GH treatment was not associated with a higher incidence of aneurysms, intracerebral hemorrhages, microbleeds or other vascular abnormalities.

The French population-based cohort of the Safety and Appropriateness of Growth hormone treatments in Europe (SAGhE) study reported increased cerebrovascular morbidity due to hemorrhagic stroke in GH-treated subjects, including those born SGA, compared with the general population (1). The main limitation of SAGhE was the absence of an appropriate control group of untreated SGA subjects to distinguish whether the increased cerebrovascular morbidity was linked to GH treatment or secondary to the underlying condition leading to be born SGA.

The current study investigated cerebrovascular abnormalities using MRI in SGA adults treated with rhGH (SGA-GH) 12 years after GH cessation (mean GH treatment duration 8.3±2.3 years), around the age of 30 years, in comparison with 3 untreated age-matched control groups: untreated short adults born SGA (SGA-S), adults born SGA with spontaneous catch-up growth and normal height (SGA-CU), and AGA adults.

The study population consisted of 301 patients, of whom 94 SGA-GH, 42 SGA-S, 69 SGA-CU and 96 AGA. Aneurysms were found in 6 adults: 3 (3.6%) SGA-GH, 1 (2.9%) SGA-S and 2 (2.2%) AGA adults, without significant differences between SGA-GH and controls. Previous intracerebral hemorrhages were found in 2 SGA-S adults (4.8%). Microbleeds were found in 17 adults: 4 (4.3%) SGA-GH, 4 (9.5%) SGA-S, 3 (4.3%) SGA-CU and 6 (6.3%) AGA adults, without significant differences between SGA-GH and controls.

In conclusion, this prospective case-control study shows that rhGH treated SGA patients do not have an increased risk of cerebrovascular abnormalities 12 years after GH therapy in comparison with closely matched controls.

Reference: 1. Poidvin A, Touzé E, Ecosse E, Landier F, Béjot Y, Giroud M, Rothwell PM, Carel JC, Coste J. Growth hormone treatment for childhood short stature and risk of stroke in early adulthood. Neurology. 2014 Aug 26;83(9):780-6. doi: 10.1212/WNL.0000000000000737. Epub 2014 Aug 13. PMID: 25122206.