Sermorelin - A review of its use in the diagnosis and treatment of children with idiopathic growth hormone deficiency

Sermorelin, a 29 amino acid analogue of human growth hormone-releasing horm one (GHRH), is the shortest synthetic peptide with full biological activity of GHRH. Intravenous and subcutaneous sermorelin specifically stimulate gr owth hormone secretion from the anterior pituitary, Hormone responses to intravenous sermorelin 1 mu g/kg bodyweight appear to be a rapid and relatively specific test for the diagnosis of growth hormone deficiency, False positive growth hormone responses are observed in fewer children without growth hormone deficiency after sermorelin than after othe r provocative tests, Adult data indicate that the combination of intravenou s sermorelin and arginine is a more specific test and this merits evaluatio n in children with growth hormone deficiency. However, normal growth hormon e responses to intravenous sermorelin cannot exclude growth hormone deficie ncy due to a hypothalamic deficit: subnormal growth hormone response to oth er provocative tests is needed to confirm the presence of disease in these patients, Limited data indicate that once daily subcutaneous sermorelin 30 mu g/kg bo dyweight given at bedtime is effective in treating some prepubertal childre n with idiopathic growth hormone deficiency. Significant increases in heigh t velocity were sustained during 12 months' treatment with sermorelin and d ata in a few children suggest the effect is maintained for 36 months of con tinued treatment. Sermorelin induced catch-up growth in the majority of gro wth hormone-deficient children. Slow growing, shorter children with delayed bone and height age appear to have a good response to treatment with sermo relin, The effect of long term treatment with once daily subcutaneous sermo relin 30 mu g/kg bodyweight on final adult height is yet to be determined. The effects of the recommended dosage of sermorelin have not been directly compared with those of somatropin, However, increases in height velocity fr om baseline values with subcutaneous sermorelin 30 mu g/kg bodyweight per d ay, given as continuous infusion or as 3 divided doses, were less than thos e in children receiving once daily subcutaneous somatropin 30 mu g/kg bodyw eight, Intravenous single dose and repeated once daily subcutaneous doses of sermo relin are well tolerated. Transient facial flushing and pain at injection s ite were the most commonly reported adverse events. Conclusions: Sermorelin is a well tolerated analogue of GHRH which is suita ble for use as a provocative test of growth hormone deficiency when given a s a single intravenous 1 mu g/kg bodyweight dose in conjunction with conven tional tests. Limited data suggest that once daily subcutaneous sermorelin 30 mu g/kg bodyweight is effective in promoting growth in some prepubertal children with idiopathic growth hormone deficiency.