Abstract
CONTEXT: Patients with adult-onset craniopharyngioma (CP) show metabolic dysfunction and panhypopituitarism. Growth hormone (GH) deficiency is often left unaddressed despite the benefits of GH replacement on body composition and lipoprotein metabolism in the general population. OBJECTIVE: The aim was to analyze data from Hypopituitary Control and Complications Study (HypoCCS), a global prospective surveillance study of adult GH replacement, and assess the impact of GH replacement on metabolic outcomes in adult-onset CP. METHODS: Primary outcome was a composite endpoint of adverse hepatic outcomes including metabolic dysfunction-associated steatotic liver disease; secondary outcomes included body composition, lipids, blood pressure, glycemic measures, mortality, bone density, and cardiovascular endpoints. RESULTS: In total, 592 patients with adult-onset CP were identified; 544 received GH for a median of 4.03 years (IQR 2.28-7.82). The 3972 patients with pituitary adenoma (3346 receiving GH) were analyzed for context. GH replacement did not impact hepatic outcomes in either cohort. In adult-onset CP, bone mineral content was significantly lower with GH replacement (estimated mean [est]: 324.90 g; 95% CI -574.49, -75.31; P = .034); lower waist-hip ratio and less dyslipidemia medication use were also seen. In pituitary adenomas, fasting blood glucose (est 6.45; 95% CI 3.24, 9.66; P < .001), diastolic blood pressure (est 1.44; 95% CI 0.45, 2.43; P = .005), and mean arterial pressure (est 1.20; 95% CI 0.14, 2.26; P = .027) were significantly higher. CONCLUSION: GH led to decreased waist-hip ratio and lipid medication use but adversely impacted bone mineral content in adult-onset CP. Prospective studies of GH replacement in adult-onset CP can further define the benefits on metabolic outcomes in these patients.