Pituitary Gland Adrenal Gland ThyroidParathyroid Thyrotoxicosis Bone Health

Pituitary Gland Adrenal Gland Thyroid/Parathyroid Thyrotoxicosis Bone Health Skin + Heart $100 $100 $200 $200 $300 $300 $400 $400 $500 $500 1

Pituitary $400 -45 year old male s/p pituitary surgery 7 years ago Growth Hormone 2. 4 ng/m. L after Macimorelin Stimulation Test

What is Growth Hormone Deficiency nd 2 to Previous Pituitary Surgery?

Typical Symptoms of Growth Hormone Deficiency • • Low energy or weakness Muscle loss Anxiety and/or depression Bone loss Dry or thinning skin Declining libido, sexual desire, or erectile dysfunction Lack of enthusiasm, drive or motivation Poor focus or concentration, memory issues

Growth Hormone Provocative Tests • Insulin tolerance test (IV)-7 GH measurements between 20 -90 minutes after hypoglycemia is achieved (<40 mg/d. L) “Gold Standard” • GHRH-arginine (IV)-4 GH measurements between 30120 minutes • Glucagon stimulation test (IM)-9 GH measurements between 0 -240 minutes • Arginine alone (IV)-4 GH measurements between 30 -120 minutes • Macimorelin (Oral)-4 GH measurements between 30 -90 minutes Discoveries 2018; 6: e 82

Diagnostic Results Growth Hormone (GH) Levels • Peak GH levels of 10 ng/m. L excluded classic growth hormone deficiency • In partial growth hormone deficiency GH peak of 5 -10 ng/m. L may be seen • In classical growth hormone deficiency a GH peak is not detected or GH peak is less than 3 ng/m. L in all samples tested

Macrilen (Macimorelin) Oral Solution • Macimorelin, an orally available ghrelin agonist that stimulates GH secretion • Indicated for the diagnosis of adult (not pediatric) growth hormone deficiency (GHD) • Recommended dose is 0. 5 mg/kg as a single oral dose, after fasting for at least 8 hours • GH level of less than 2. 8 ng/m. L confirms GHD • Macrilen and the insulin tolerance test were in complete agreement among 89% of subjects studied; FDA approved December 20, 2017

Ghrelin Stimulates Growth Hormone Secretion

Pituitary Gland Adrenal Gland Thyroid/Parathyroid Thyrotoxicosis Bone Health Skin + Heart $100 $100 $200 $200 $300 $300 $400 $400 $500 $500