Purpose <p>Craniopharyngiomas (CPs) cause hypopituitarism in most patients, with growth hormone deficiency (GHD) being the most prevalent form. Growth hormone replacement therapy (GHRT) is the standard treatment for GHD, but the impact of this therapy on CP recurrence remains unclear. This study aimed to evaluate the effect of GHRT on CP recurrence in both pediatric and adult populations.</p> Methods <p>The PubMed, Cochrane Library, Web of Science, Embase and ClinicalTrials.gov databases were systematically searched in accordance with the 2020 PRISMA guidelines. Original studies comparing the impact of GHRT and non-GHRT on CP recurrence were included. Among the 817 initially identified records, 12 studies met the inclusion criteria. Two independent investigators extracted the data and assessed the quality of the included studies.</p> Results <p>The meta-analysis revealed that GHRT significantly reduced the risk of recurrence (OR = 0.56, 95% CI 0.41–0.77). Subgroup analyses revealed that GHRT had a more significant effect among patients with a follow-up period of more than five years. Initiating GHRT within 12 months after CP treatment significantly reduced the recurrence rate (OR = 0.32, 95% CI 0.16–0.62). Sensitivity analyses and publication bias tests revealed that the results were robust.</p> Conclusions <p>The meta-analysis shows that GHRT does not increase the risk of recurrence in CP, even when initiated within 12 months postoperatively. GHRT should be considered an essential treatment for CP patients with GHD.</p>