1. Pituitary Gland
Thyrotoxicosis
Adrenal Gland
Thyroid/Parathyroid
Bone Health
Skin + Heart
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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. 2nd to Previous Pituitary Surgery?
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
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.

5. Growth Hormone Provocative Tests
Insulin tolerance test (IV)-7 GH measurements between minutes after hypoglycemia is achieved (<40 mg/dL) “Gold Standard”
GHRH-arginine (IV)-4 GH measurements between minutes
Glucagon stimulation test (IM)-9 GH measurements between minutes
Arginine alone (IV)-4 GH measurements between minutes
Macimorelin (Oral)-4 GH measurements between 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
Thyrotoxicosis
Adrenal Gland
Thyroid/Parathyroid
Bone Health
Skin + Heart
$100
$100
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