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Growth Hormone Deficiency Post Pituitary Surgery - Diagnostic Tests and Macimorelin Oral Solution

Learn about the symptoms and diagnostic tests for growth hormone deficiency after pituitary surgery. Discover how Macimorelin oral solution can help in diagnosing adult growth hormone deficiency.

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Growth Hormone Deficiency Post Pituitary Surgery - Diagnostic Tests and Macimorelin Oral Solution

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

  2. Pituitary $400-45 year old male s/p pituitary surgery 7 years ago • Growth Hormone 2.4 ng/mL after Macimorelin Stimulation Test

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

  4. 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

  5. Growth Hormone Provocative Tests • Insulin tolerance test (IV)-7 GH measurements between 20-90 minutes after hypoglycemia is achieved (<40 mg/dL) “Gold Standard” • GHRH-arginine (IV)-4 GH measurements between 30-120 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:e82

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

  7. 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/mL confirms GHD • Macrilen and the insulin tolerance test were in complete agreement among 89% of subjects studied; FDA approved December 20, 2017

  8. Ghrelin Stimulates Growth Hormone Secretion

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

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