A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .
Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas: a case control study.
OBJECTIVE Several studies documented metabolic and psychological benefits of GH substitution in deficient adults , most of them suffering from benign pituitary adenomas . Since GH substitution is considered to promote tumour regrowth , adequate treatment is performed with some reservation . Therefore , we aim ed to eluci date the effect of GH replacement therapy on tumour recurrence following surgery . METHODS In patients with hormonally inactive pituitary adenomas undergoing tumour surgery , a retrospective case-control study was performed . Pre- and postoperative magnetic resonance ( MR ) images of GH-treated and untreated patients were matched for best fit by two independent observers . The treated patients were retrieved from the surveillance programme of the German KIMS data base and the untreated from the data base of the Department of Neurosurgery , University of Erlangen . A total of 55 matched pairs were followed for at least 5 years . Tumour recurrence and progression rates were determined according to the postoperative MR . RESULTS There were 16 tumour progressions in the treatment group and 12 in the control group . Statistical analysis revealed no significant increase in either recurrence ( P = 0.317 ) or progression ( P = 0.617 ) within the follow-up period of 5 years when GH was adequately replaced . CONCLUSIONS This study provides further observational data of substitution therapy in GH-deficient adults with pituitary adenomas . Comparing long-term surgical results , we found no evidence that GH substitution should be withheld in deficient patients . Even residual tumour does not constitute a contraindication to GH replacement . However , since pituitary tumours are slow growing , an observational period of 5 years may not have been long enough to verify any absolute influence on recurrence potential
A positive effect of GH treatment on CVD and fracture risk could be concluded , but study design limitations have to be considered .
Stroke and secondary brain tumours remained more prevalent .
Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment .
All fatal and nonfatal malignancies were not more prevalent in  GH-treated adults compared to the general population .
Due to the positive effects demonstrated in r and omized clinical trials on cardiovascular surrogate markers and bone metabolism , a positive effect of growth hormone ( GH ) treatment on clinical ly relevant end-points seems feasible .
In this review , we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency ( GHD ) with emphasis on morbidity : fatal and nonfatal cardiovascular disease ( CVD ) and stroke , fractures , fatal and nonfatal malignancies and recurrences , and diabetes mellitus .