Sermorelin Use in Adults
Sermorelin is not recommended for routine use in adults with growth hormone deficiency—recombinant human growth hormone (rhGH) replacement therapy is the established standard of care. 1
Why Sermorelin Is Not Standard Therapy in Adults
The evidence base for sermorelin in adults is essentially absent. The available literature focuses almost exclusively on:
Current guidelines from the Endocrine Society and American Association of Clinical Endocrinologists make no mention of sermorelin as a therapeutic option for adults with GHD, instead consistently recommending recombinant human GH as the treatment of choice. 1
Established Adult GHD Treatment: Recombinant Human GH
GH replacement should be considered routine management for adults with confirmed hypopituitarism and GHD, with demonstrated benefits including:
- Decreased body weight, waist circumference, and visceral adiposity 1
- Improved total and LDL cholesterol profiles 1
- Improved bone mineral density 1, 4
- Enhanced quality of life and psychological well-being 1, 4
- Reduced morbidity and mortality 4
Dosing Algorithm for Adult rhGH Therapy
Start with no more than 0.04 mg/kg/week given as daily subcutaneous injection, with the following adjustments: 1
- Adjust dose at 4- to 8-week intervals according to individual requirements 1
- Weight-based dosing should be adjusted regularly 1
- Monitor IGF-I levels to guide dosing (though IGF-I alone cannot diagnose GHD) 1
Long-Term Monitoring Requirements
Lifelong annual clinical and biochemical monitoring is essential, including: 1
- Surveillance for both under-replacement and over-replacement 1
- Monitoring for psychiatric and neurocognitive effects 1
- Assessment of bone mineral density in young adults prior to adult transition 1
Limited Historical Context on Sermorelin
The only substantive data on sermorelin comes from pediatric studies showing:
- Diagnostic utility: Intravenous sermorelin 1 mcg/kg appears to be a rapid and relatively specific test for diagnosing GH deficiency in children, with fewer false positives than other provocative tests 2
- Pediatric treatment: Subcutaneous sermorelin 30 mcg/kg at bedtime showed some efficacy in prepubertal children with idiopathic GHD, though increases in height velocity were less than those achieved with somatropin 2
These pediatric findings have not translated into adult therapeutic applications, and no modern guidelines support sermorelin use in adults. 1
Critical Pitfall to Avoid
Do not delay or substitute established rhGH therapy with sermorelin in adults with confirmed GHD. The consequences of untreated adult GHD include increased cardiovascular risk, metabolic dysfunction, reduced bone density, and impaired quality of life—all of which improve with rhGH replacement. 4, 5