From the Guidelines
Sermorelin should be used with caution and under close medical supervision, as it can contribute to an increased risk of slipped capital femoral epiphysis, particularly in patients with growth hormone deficiency or those undergoing growth hormone treatment. Sermorelin is a synthetic peptide that stimulates the release of growth hormone from the pituitary gland, typically prescribed at doses of 100-500 mcg injected subcutaneously once daily, usually before bedtime when natural growth hormone pulses are highest 1. It's used to treat growth hormone deficiency in both children and adults, and some physicians prescribe it off-label for anti-aging purposes. The medication requires refrigeration and is typically administered using insulin syringes into the abdomen or thigh. Common side effects include injection site reactions, headache, flushing, and dizziness. Sermorelin works by mimicking growth hormone-releasing hormone (GHRH), binding to receptors in the pituitary gland to stimulate natural growth hormone production rather than directly replacing growth hormone. This approach may provide more physiological hormone patterns and potentially fewer side effects than direct growth hormone replacement.
Key Considerations
- Treatment duration varies based on the condition being treated, with some patients using it for months or years under medical supervision 1.
- Regular blood tests to monitor IGF-1 levels are important to ensure appropriate dosing and response.
- Patients with chronic kidney disease may require closer monitoring, as growth hormone treatment can affect renal function and increase the risk of slipped capital femoral epiphysis 1.
- The benefits of growth hormone treatment in specific patient subgroups, such as prepubertal patients with chronic kidney disease, have been demonstrated in clinical trials, with significant increases in height velocity and mean height SDS 1.
Monitoring and Adverse Effects
- Clinic visits every 3-6 months or more frequently for young patients and those with advanced chronic kidney disease are recommended to monitor stature, height velocity, pubertal development, skeletal maturation, renal function, thyroid hormone levels, serum glucose, calcium, phosphate, bicarbonate, and parathyroid hormone levels 1.
- Growth hormone treatment should be stopped if the patient develops slipped capital femoral epiphysis, intracranial hypertension, or persistent severe secondary hyperparathyroidism, or if the patient does not adequately respond to treatment despite optimal nutritional and metabolic control 1.
From the FDA Drug Label
ADVERSE REACTIONS Reactions which may occur because of this solution, added drugs or the technique of reconstitution or administration include febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection and extravasation The adverse reactions of Sermorelin (IV) include:
- Febrile response
- Local tenderness
- Abscess
- Tissue necrosis or infection at the site of injection
- Venous thrombosis or phlebitis extending from the site of injection
- Extravasation 2
From the Research
Sermorelin Overview
- Sermorelin is a 29 amino acid analogue of human growth hormone-releasing hormone (GHRH) with full biological activity of GHRH 3
- It is used in the diagnosis and treatment of children with idiopathic growth hormone deficiency
Diagnosis of Growth Hormone Deficiency
- Intravenous sermorelin 1 microg/kg bodyweight is a rapid and relatively specific test for the diagnosis of growth hormone deficiency 3
- False positive growth hormone responses are observed in fewer children without growth hormone deficiency after sermorelin than after other provocative tests 3
Treatment of Growth Hormone Deficiency
- Once daily subcutaneous sermorelin 30 microg/kg bodyweight is effective in treating some prepubertal children with idiopathic growth hormone deficiency 3, 4
- Significant increases in height velocity were sustained during 12 months' treatment with sermorelin 3
- Sermorelin induced catch-up growth in the majority of growth hormone-deficient children 3
Safety and Tolerability
- Sermorelin is well tolerated, with transient facial flushing and pain at injection site being the most commonly reported adverse events 3
- No adverse changes in general biochemical or hormonal analyses were noted in children treated with sermorelin 4
Effects on Insulin Sensitivity and Glucose Metabolism
- Growth hormone therapy, including sermorelin, may have an independent adverse effect on insulin sensitivity and could worsen cardiovascular risk 5
- However, sermorelin therapy has been shown to increase serum insulin-like growth factor-1 (IGF-1) levels without significant changes in fasting glucose concentration or excessive generation of IGF-1 6