Sermorelin: Clinical Uses
Sermorelin is a synthetic growth hormone-releasing hormone (GHRH) analogue used primarily for diagnostic testing of growth hormone deficiency in children, and has limited therapeutic application for treating idiopathic growth hormone deficiency in select prepubertal children. 1
Diagnostic Use
Sermorelin serves as a provocative test for diagnosing growth hormone deficiency when administered as a single intravenous dose of 1 mcg/kg body weight. 1
- The test specifically stimulates growth hormone secretion from the anterior pituitary, providing a rapid and relatively specific assessment of pituitary function 1
- Sermorelin produces fewer false-positive results compared to other provocative tests in children without true growth hormone deficiency 1
- A critical limitation: normal growth hormone responses to sermorelin cannot exclude growth hormone deficiency due to hypothalamic dysfunction, requiring confirmation with additional provocative tests 1
Therapeutic Use (Limited)
Subcutaneous sermorelin at 30 mcg/kg body weight given once daily at bedtime has shown efficacy in treating some prepubertal children with idiopathic growth hormone deficiency, though it is not first-line therapy. 1
Treatment Response
- Significant increases in height velocity were sustained during 12 months of treatment, with limited data suggesting effects may persist for 36 months 1
- Sermorelin induced catch-up growth in the majority of growth hormone-deficient children treated 1
- Children who are slow-growing, shorter, with delayed bone age and delayed height age appear to have the best response to sermorelin therapy 1
Important Limitations
Sermorelin is less effective than recombinant human growth hormone (somatropin) for therapeutic purposes. 1
- Height velocity increases with subcutaneous sermorelin 30 mcg/kg/day (given as continuous infusion or divided doses) were inferior to those achieved with once-daily subcutaneous somatropin 30 mcg/kg/day 1
- The effect of long-term sermorelin treatment on final adult height remains undetermined 1
Safety Profile
Sermorelin is well-tolerated with minimal adverse effects. 1
- Transient facial flushing and pain at injection site are the most commonly reported adverse events 1
- Both single intravenous doses and repeated daily subcutaneous doses demonstrate good tolerability 1
Clinical Context
Recombinant human growth hormone (rhGH), not sermorelin, is the established first-line treatment for growth hormone deficiency in children. 2, 3
- rhGH has been the standard since 1985 and is recommended for normalizing height during childhood and achieving adult height within normal and target height ranges 2
- For children with chronic kidney disease and growth failure, rhGH at 0.045-0.05 mg/kg/day is the recommended therapy, not sermorelin 4, 5
- Growth hormone therapy requires careful monitoring every 3-6 months for height velocity, pubertal development, skeletal maturation, and metabolic parameters 6, 5
In summary, sermorelin's primary clinical utility is as a diagnostic tool for growth hormone deficiency, while its therapeutic role is limited to select cases of idiopathic growth hormone deficiency where it remains inferior to standard rhGH therapy.