What are the risks of sermorelin (growth hormone-releasing hormone (GHRH) analogue) therapy?

From the Guidelines

Sermorelin therapy carries several important risks that patients should be aware of before starting treatment, including potential development of antibodies against growth hormone-releasing hormone, elevated blood glucose levels, insulin resistance, and potentially worsened diabetes in susceptible individuals, as well as concerns about increased risk of cancer and fluid retention, joint and muscle pain, and carpal tunnel syndrome. Common side effects include pain, redness, or swelling at the injection site, headache, facial flushing, dizziness, and hyperactivity. More serious risks include potential development of antibodies against growth hormone-releasing hormone which can reduce effectiveness over time. Sermorelin may also cause elevated blood glucose levels, insulin resistance, and potentially worsen diabetes in susceptible individuals. There are concerns about potential increased risk of cancer, particularly in patients with pre-existing malignancies or risk factors, as growth hormone can theoretically promote cell growth. Fluid retention, joint and muscle pain, and carpal tunnel syndrome may occur during treatment. Sermorelin can also cause pituitary enlargement with long-term use. Allergic reactions, though rare, can happen and may be severe in some cases. The medication should be used cautiously in patients with thyroid disorders, as it may affect thyroid function. Additionally, sermorelin's long-term safety profile is not as well established as some other medications, and it's essential to note that many of these risks are similar to those associated with direct growth hormone therapy, though potentially less severe due to sermorelin's indirect mechanism of action through stimulating natural growth hormone production 1.

Some key points to consider when evaluating the risks of sermorelin therapy include:

• The potential for sermorelin to cause elevated blood glucose levels and insulin resistance, which may be particularly concerning for patients with pre-existing diabetes or those at risk for developing diabetes 1
• The potential for sermorelin to increase the risk of cancer, particularly in patients with pre-existing malignancies or risk factors, as growth hormone can theoretically promote cell growth 1
• The potential for sermorelin to cause fluid retention, joint and muscle pain, and carpal tunnel syndrome, which may be particularly concerning for patients with pre-existing joint or muscle problems 1
• The potential for sermorelin to cause pituitary enlargement with long-term use, which may be particularly concerning for patients with pre-existing pituitary problems 1
• The potential for sermorelin to cause allergic reactions, though rare, which can happen and may be severe in some cases 1

It's crucial to weigh the potential benefits of sermorelin therapy against the potential risks and to carefully monitor patients for any adverse effects during treatment. Patients should be informed of the potential risks and benefits of sermorelin therapy and should be closely monitored by a healthcare provider during treatment.

From the Research

Risks of Sermorelin Therapy

The risks associated with sermorelin therapy are primarily related to its mechanism of action as a growth hormone-releasing hormone (GHRH) analogue. While sermorelin is generally well-tolerated, there are potential risks to consider:

• Transient facial flushing and pain at the injection site are the most commonly reported adverse events 2
• The use of sermorelin can lead to increased growth hormone secretion, which may cause symptoms such as headache or visual field disturbances in some cases
• Ectopic production of GHRH by neuroendocrine tumors (NETs) is a rare cause of acromegaly, and sermorelin therapy may exacerbate this condition 3, 4, 5, 6
• Prolonged exposure to elevated GHRH levels can lead to persistent pituitary hyperplasia or GH-adenomas, even without NET recurrence 3, 4, 5

Specific Risks in Certain Populations

Certain populations may be at higher risk for adverse events related to sermorelin therapy:

• Children with idiopathic growth hormone deficiency may experience significant increases in height velocity with sermorelin treatment, but the long-term effects on final adult height are not yet determined 2
• Patients with multiple endocrine neoplasia type 1 (MEN-1) may be at risk for ectopic GHRH secretion and should be screened for this condition 5
• Patients with acromegaly secondary to GHRH secretion may require alternative treatment approaches, such as surgical resection of the tumor or somatostatin analogue therapy 3, 4, 5, 6