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 .
Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?
OBJECTIVE Hypopituitary GH-deficient patients have an increased cardiovascular mortality and GH replacement in this population has result ed in considerable therapeutic benefit . GH replacement involves administration of a potentially mitogenic substance to patients with a previous or residual pituitary tumour . Our objective was to evaluate whether GH replacement results in an increase in the size of pituitary tumours . METHODS This was a non-r and omised observational study on patients recruited from the endocrine clinic . All subjects had GH deficiency , proven on an insulin tolerance test and were divided into those who were or were not receiving long-term GH replacement .  Comparison of change in pituitary size was made with interval radiological imaging of the pituitary . RESULTS Seventy-five patients ( 40 men and 35 women ) were in the study , 47 were on long-term GH replacement and there were 28 controls . The average length of treatment for the treated group was 3.6 patient years . Thirty-nine patients in the treated group had at least 2 years of GH treatment between imaging studies of the pituitary . Two patients in the treated group had an increase in pituitary size ( non-functioning adenomas ) and two in the control group ( one functioning and one non-functioning adenoma adenoma ) . None of these four patients required further treatment . There was no statistically significant difference between the two groups . CONCLUSION Using a representative cohort of hypopituitary patients attending an endocrine clinic , GH replacement was not associated with an increased pituitary tumour recurrence rate . Although the results are not conclusive , in the period of observation GH had little adverse effect but longer studies are required to be certain
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 .