成長ホルモン補償療法中に腫瘍再発を来した2症例

Two Cases of Recurrent Brain Tumor during GH Replacement Therapy

I．はじめに

　下垂体性小人症に対する唯一の治療法は，その原因の如何にかかわらず，ヒト成長ホルモン（hGH）による補償療法である．過去においてはヒト下垂体からの抽出製剤のみにたよっていたが，今日では遺伝子組換え操作の発展により人量のhGHが得られるようになり，同疾患に悩む子どもたちに大きな救いとなっている．

　われわれは，hGH補償療法中に再発を来した脳腫瘍患者2例を経験したので，hGH投与と脳腫瘍再発との関係について若干の文献的考察を加えて報告する．

Two cases of patients with recurrent brain tumor are presented. Each of them received growth hormone (GH) replacement therapy for growth failure secondary to cra-nial irradiation.

The first case is that of a 10-year-old girl who was treated with a combination of surgical resection, radio-therapy and chemotherapy for cerebellar medulloblastoma at I y.o. At the age of 9, 10 month after the beginning of GH replacement therapy, she complained of headache. This was clue to shunt malfunction when CSF cytology was class V.It revealed that there was recurrence of medulloblastoma.

The second case is that of a 14-year-old girl who was treated with a combination of surgical resection, radiotherapy and chemotherapy for suprasellar germino-ma at the age of 10. This tumor completely disappeared after these procedures. For her growth failure, we started GH replacement therapy and after 1 year, she com-plained of It. leg pain clue to tibial and pelvic bone meta-stasis.

In medical literature, we found 15 recurrent brain tumors during GH replacement therapy. These include our 2 cases, and 9 cases in which there was recurrence within 1 year.

Recently, receptors for some somatomedins have been found in brain tumors. Although these numbers are too small for us to arrive at conclusions, we think it is pos-sible that there are some mechanisms connecting GH re-placement therapy and recurrence of certain brain tumors.