Pituitary Gland Thyrotoxicosis Adrenal Gland 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

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

2nd to Previous Pituitary Surgery? What is Growth Hormone Deficiency 2nd 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 The typical symptoms of low HGH include: Low energy or weakness Muscle loss Bone loss Dry or thinning skin Low HGH symptoms also include declining libido, sexual desire, or erectile dysfunction Lack of enthusiasm, drive or motivation because of low HGH. Anxiety, and/or depression Poor focus or concentration, memory issues from having low HGH levels.

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

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

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

Ghrelin Stimulates Growth Hormone Secretion

Pituitary Gland Thyrotoxicosis Adrenal Gland 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