Palui R, Sridharan K, Kamalanathan S, Sahoo J, Naik D. Growth hormone and gastrointestinal malignancy: An intriguing link. World J Gastrointest Pathophysiol 2023; 14(1): 1-11 [PMID: 36743656 DOI: 10.4291/wjgp.v14.i1.1]
Corresponding Author of This Article
Jayaprakash Sahoo, MD, DM, Additional Professor & Head, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Room 5444, Fourth Floor, Super specialty Block, D. Nagar, Puducherry 605006, India. jppgi@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pathophysiol. Jan 22, 2023; 14(1): 1-11 Published online Jan 22, 2023. doi: 10.4291/wjgp.v14.i1.1
Growth hormone and gastrointestinal malignancy: An intriguing link
Rajan Palui, Kalyani Sridharan, Sadishkumar Kamalanathan, Jayaprakash Sahoo, Dukhabandhu Naik
Rajan Palui, Department of Endocrinology, The Mission Hospital, Durgapur 713212, West Bengal, India
Kalyani Sridharan, Department of Endocrinology, All India Institute of Medical Science, Rishikesh 249203, Uttarakhand, India
Sadishkumar Kamalanathan, Jayaprakash Sahoo, Dukhabandhu Naik, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Palui R and Sridharan K acquired the data and drafted the manuscript; Sahoo J, Kamalanathan S, and Naik D conceptualized the work, supervised the writing, provided intellectual input, and critically revised the manuscript; All authors approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jayaprakash Sahoo, MD, DM, Additional Professor & Head, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Room 5444, Fourth Floor, Super specialty Block, D. Nagar, Puducherry 605006, India. jppgi@yahoo.com
Received: November 16, 2022 Peer-review started: November 16, 2022 First decision: December 11, 2022 Revised: December 25, 2022 Accepted: January 17, 2023 Article in press: January 17, 2023 Published online: January 22, 2023 Processing time: 64 Days and 18.3 Hours
Abstract
Growth hormone (GH) excess is associated with several systemic complications, one of which is the increased risk of neoplastic processes particularly of the gastrointestinal (GI) tract. Among the GI neoplasms, the most reported association is with benign and malignant neoplasms of the colon. In the majority of published literature, an increased incidence of GI neoplasms, both colonic adenomas as well as colorectal carcinoma is reported. However, the studies on colon cancer-specific mortality rate are conflicting with recent studies reporting similar cancer-specific mortality rates in comparison to controls. Many studies have reported an association of colorectal neoplasms with GH levels. Pathogenic mechanisms put forward to explain this association of GH excess and GI neoplasms primarily involve the increased GH-insulin-like growth factor 1 (IGF-1) signaling. Both GH and IGF-1 have proliferative, anti-apoptotic, and angiogenic effects on the systemic tissues leading to cellular proliferation. Other contributing factors to the increased risk of GI neoplasms include slow intestinal transit with a redundant large bowel, altered bile acids, deranged local immune response, shared genetic susceptibility factors and hyperinsulinemia. In view of the increased risk association, most guidelines for the care of acromegaly patients recommend an initial screening colonoscopy. Recommendations for further follow-up colonoscopy differ but broadly, the guidelines agree that it depends on the findings at first colonoscopy and state of remission of GH excess. Regarding the concern about the risk of colorectal cancers in patients receiving recombinant GH therapy, most cohort studies do not show an increased risk.
Core Tip: Growth hormone (GH) excess is associated with systemic complications including an increased risk of gastrointestinal (GI) neoplasms. Although most studies show an increased incidence of all GI neoplasms, most evidence is for increased colorectal adenomas and carcinomas. However, recent studies show similar colon cancer-specific mortality rates in acromegaly as compared to the general population. Screening guidelines for acromegaly recommend an initial colonoscopy in all patients with further follow-up recommended for patients with high risk. Most cohort studies do not report any increased risk of GI neoplasms for patients on recombinant GH therapy.
