Growth Hormone Replacement in Older Men Medication

  • Author: Angela Gentili, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Nov 18, 2011
 

Medication Summary

According to a 2011 systematic review, GH replacement[14] is effective in reversing some of the changes that occur in older adults (aged >60 y) with GH deficiency secondary to hypopituitarism. The effects of GH replacement in these patients include the following:

  • Decreased waist circumference (by about 3 cm) and waist-to-hip ratio without changing BMI; GH increased lean body mass and decreased total fat mass in 4 studies but not in another 2.
  • Reduction in total cholesterol level by 4-8% and low-density lipoprotein cholesterol (LDL) by 11-16% but no change in HDL and triglycerides
  • Improvement in quality of life
  • No consistent improvement in blood pressure or bone mineral density; additionally, no data are available on GH-deficient patients older than 80 years
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Growth hormones

Class Summary

Most studies of GH supplementation in healthy older people (not GH deficient) have shown that in both men and women, GH increases muscle mass and decreases body fat, but it does not improve strength. In a 6-month study, the combination of testosterone and GH also increased total body isotonic strength and aerobic capacity in older men.[15] GH reduced serum leptin and LDL-C and increased triglycerides, with no effect on HDL.[16] Common side effects were arthralgias and carpal tunnel syndrome.

One month of a small dose of GH (ie, 6.25 mcg/kg/d) alone or in combination with transdermal testosterone did not improve strength, flexibility, or percentage of body fat, but it improved certain measures of balance and physical performance in healthy older men. At such a small dose, there were no significant adverse events. In another study, GH did not enhance the positive effect of exercise on muscle strength.[17, 18]

A systematic review of randomized trials of GH therapy in 220 older men and women reported that GH therapy decreased fat mass and increased lean body mass without change in weight. Despite the improvement in body composition, persons treated with GH were significantly more likely to develop soft tissue edema, arthralgias, carpal tunnel syndrome, and gynecomastia. The authors concluded that GH cannot be recommended as antiaging therapy.[6]

GH secretagogues that would produce a more physiological increase in circulating GH levels are under investigation. These include GHRH and the growth hormone releasing peptides (GHRPs) and their analogs. Six months treatment with daily GHRH improved performance in cognitive tests compared to placebo in healthy older adults. An orally active GH secretagogue, MK-0677, was studied in older adults with recent hip fractures.[19] Although it increased serum IGF-1, it did not improve functional performance measures significantly.[20]

GH treatment in frail older people

In a placebo-controlled trial of patients aged 64-99 years who were malnourished, GH caused a rise in circulating IGF-1, an average weight gain of 2.2 kg, and an increase in nitrogen retention.[21] Older individuals are more sensitive to GH replacement than children and young adults; therefore, the dose of GH must be lower. Treating older adults with the amount of GH produced in healthy puberty (ie, 23-35 mcg/kg/d) can cause glucose intolerance, arthralgias, fluid retention, carpal tunnel syndrome, and, rarely, papilledema.

View full drug information

Growth hormone; somatropin (Genotropin, Humatrope, Norditropin)

 

Obtained by recombinant DNA technology. Amino acid sequence is identical to that of pituitary-derived hGH. Indicated in pediatrics to treat growth failure due to lack of adequate endogenous GH secretion, growth failure associated with chronic renal insufficiency up to the time of renal transplantation, and short stature associated with Turner syndrome. Indicated in adults to treat a biochemical diagnosis of adult GHD by means of a subnormal response to a standard GH stimulation test; patients who have adult GHD, either alone or with multiple hormone deficiencies (hypopituitarism) as a result of pituitary disease, hypothalamic disease, surgery, radiation therapy, or trauma; or patients who were GH deficient during childhood, confirmed as an adult before replacement therapy with somatropin is started.

Not FDA approved for older patients who do not meet the above criteria of adult GHD. Its use for hyposomatotropism of aging should be considered investigational.

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Contributor Information and Disclosures
Author

Angela Gentili, MD  Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center

Angela Gentili, MD is a member of the following medical societies: American Geriatrics Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Adler, MD  Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University

Robert A Adler, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Bone and Mineral Research, and Endocrine Society

Disclosure: Eli Lilly Grant/research funds Independent contractor; Genentech Grant/research funds Independent contractor

Specialty Editor Board

Barry J Goldstein, MD, PhD  Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Professor, Department of Internal Medicine, Thomas Jefferson University

Barry J Goldstein, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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