Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1613-1622 (doi:10.1542/peds.2004-1004)
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Cardiac Changes Associated With Growth Hormone Therapy Among Children Treated With Anthracyclines

Steven E. Lipshultz, MD*, Sarah A. Vlach, MD{ddagger}, Stuart R. Lipsitz, DSc§, Stephen E. Sallan, MD||,¶,#, Marcy L. Schwartz, MD{ddagger},¶ and Steven D. Colan, MD{ddagger},¶

* Department of Pediatrics, Miller School of Medicine at the University of Miami, Holtz Children's Hospital of the University of Miami-Jackson Memorial Medical Center, and the Sylvester Comprehensive Cancer Center, Miami, Florida
{ddagger} Department of Cardiology and
|| Division of Hematology-Oncology, Children's Hospital, Boston, Massachusetts
§ Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
# Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

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.

Key Words: growth hormone • anthracyclines • cardiac changes • cardiomyopathy • pediatric cancer • congestive heart failure

Abbreviations: LV, left ventricular • GH, growth hormone

Accepted Oct 6, 2004.


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