Potential applications of GH secretagogs in the evaluation and treatment of the age-related decline in growth hormone secretion

The two classes of GH secretagogs—GH-releasing hormone (GHRH) and the GH-releasing peptides and their analogs (GHRP’s)—retain their ability to endogenous GH secretion in healthy and frail elderly subjects. They have very limited utility in assessment of the state of the GH/IGF-I axis except to confirm an intact pituitary, but they are attractive potential alternatives to GH as therapeutic agents. There is wide interest in the possibility that elevating GH and IGF-I might increase muscle mass, physical strength and performance, and possibly sleep and cognition in aging. The GH secretagogs, like GH, can produce a sustained stimulation of this axis; in contrast to GH, they preserve feedback regulation at the pituitary level and stimulate a near-physiologic pulsatile pattern of GH release. GHRP’s and their nonpeptide analogs are also active when given orally, a significant practical advantage. Short-tern treatment studies have shown that GHRH and the GHRP’s can enhance GH secretion and elevate IGF-I and IGFBP-3 levels; that GHRH may promote sleep; and that these agents are generally well tolerated. Longer-term studies, assessing effects upon body composition and physical and psychological function are underway. Prepared for presentation at “Assessment of the Growth Hormone/IGF-I Axis in Aging,” Bethesda, MD, April 14, 1997.