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Low Dose Growth Hormone (GH) on Insulin Sensitivity and Cortisol Production Rates

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Kevin Yuen, Oregon Health and Science University
ClinicalTrials.gov Identifier:
NCT00517062
First received: August 15, 2007
Last updated: May 2, 2012
Last verified: May 2012
  Purpose

Study hypothesis:

Growth hormone (GH), through its generation of free 'bioavailable' insulin-like growth factor (IGF)-I, can improve insulin sensitivity in adults with GH deficiency.

Study aims:

The purpose of this study is to determine the mechanism of how low dose GH treatment affects the body's sensitivity to insulin actions and whether this low GH dose can affect the body's handling of steroid hormone levels (cortisol clearance) in adults with GH deficiency.

Study design:

Men and women with confirmed GH deficiency, but not recently been on GH treatment will be invited to participate in this study. The subjects will be assessed at the initial visit to ascertain their suitability before further participating in the study. If suitable, an equal number of men and women will be randomized to receive either low dose GH or placebo injection for 3 months. Before, during and after treatment, the subjects will be assessed at regularly with blood tests, scans and fat biopsies. At the first and final visit, testing will include scans to measure the amount of whole body fat and fat in the stomach area, muscle, and liver; blood tests to measure levels of cortisol, and fat tissue (taken from a biopsy) analysis to measure the density of IGF-I in the muscle; whereas blood tests to examine insulin sensitivity will also be collected. This study will use Genotropin and Genotropin pen devices, and the the data will be analyzed using a computer statistical program where the identity of the subjects will be coded to maintain confidentiality.


Condition Intervention Phase
Growth Hormone Deficiency
Drug: Growth hormone (Genotropin)
Drug: Placebo
Phase 0

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effects of Low Dose Growth Hormone (GH) Therapy on Insulin Sensitivity, Adipocyte Insulin-like Growth Factor-I (IGF-I) and IGF-I/Insulin Receptor Density and Regulation of Cortisol Metabolism in GH Deficient Adults

Resource links provided by NLM:


Further study details as provided by Oregon Health and Science University:

Primary Outcome Measures:
  • Changes in insulin sensitivity (from the hyperinsulinemic euglycemic clamp [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Changes in fat IGF-I and IGF-I/insulin hybrid receptor density and body composition. [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]

Enrollment: 16
Study Start Date: January 2006
Study Completion Date: January 2012
Primary Completion Date: January 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: A
Growth hormone
Drug: Growth hormone (Genotropin)
Growth hormone 0.1 mg self-injected once a day subcutaneously at bedtime.
Other Name: Genotropin
Placebo Comparator: B
Placebo
Drug: Placebo
Placebo self-injected once a day subcutaneously at bedtime.
Other Name: Placebo.

Detailed Description:

The study will be double-blinded. One hundred subjects will be screened for eligibility initially, and 24 subjects will be enrolled with 12 subjects being randomized to receive the low GH dose (0.1 mg/day) treatment and 12 subjects to receive Placebo treatment for 3 months, allowing a 10% drop-out rate. The subjects will be taught by either by the Endocrine Nurse Specialists to self-administer the GH by subcutaneous injections using a Genotropin pen device.

Visit 1, Initial Screening Assessment (as out-patient)

  • Physical examination, weight, height, and waist circumference measurements
  • Fasting blood glucose levels

Visit 2, Baseline Assessment (as in-patient)

  • Physical examination, weight, height, and waist circumference measurements
  • Fasting blood tests for glucose, insulin, C-peptide, free IGF-I, total IGF-I, IGF-2, IGFBPs -1 and -3, non-esterified fatty acid and lipid profiles
  • MRS, abdominal CT and DEXA scans
  • One-step 3-hour hyperinsulinaemic euglycaemic clamp
  • Cortisol production rates and urine cortisol collections
  • Fat biopsies will be taken at the end of the assessment of cortisol production rates

Visit 3, Interim Assessment (Month 1) (as out-patient)

  • Documentation of any adverse effects
  • Fasting blood tests for glucose, insulin, C-peptide, free IGF-I, total IGF-I, IGF-2, IGFBPs -1 and -3

Visit 4, Final Assessment (Month 3) (as in-patient)

  • Physical examination, weight, height, and waist circumference measurements
  • Fasting blood tests for glucose, insulin, C-peptide, free IGF-I, total IGF-I, IGF-2, IGFBPs -1 and -3, non-esterified fatty acid and lipid profiles
  • MRS, abdominal CT and DEXA scans
  • One-step 3-hour hyperinsulinaemic euglycaemic clamp
  • Cortisol production rates and urine cortisol collections
  • Fat biopsies will be taken at the end of the assessment of cortisol production rates

Any extra blood remaining from the samples of blood drawn may be banked indefinitely with confidential identifiers, and may be given to researchers in the future to examine for other potential causes of diabetes and heart diseases in adults. These blood samples, however, will not be used for genetic studies.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age range 18 to 75 years
  • BMI should not exceed 40 kg/m2
  • Confirmed GH deficient with at least one provocative test, e.g. insulin tolerance test and/ or GHRH/arginine
  • Not received any GH therapy within last 6 months
  • On a stable standardized hydrocortisone replacement dose regimen (twice a day at 8 AM and 4 PM),
  • If any other pituitary hormone deficiencies are present, patient must be on optimal pituitary hormone replacement therapy, e.g. Thyroxine, testosterone and oestrogen replacement
  • Normal renal and hepatic function
  • Prepared to self-inject

Exclusion Criteria:

  • Untreated or subclinically hypo/hyperthyroid
  • Untreated or subclinically treated hypocortisolism
  • Type 1 or 2 diabetes mellitus
  • Subjects with evidence of nephropathy from any cause
  • Subjects with evidence of retinopathy from any cause
  • Any other medical illnesses that may affect the interpretation of the results
  • Pregnant
  • Emotional/social instability likely to prejudice study completion
  • Previous history of known malignancy
  • Recurrent or severe unexplained hypoglycaemia
  • Known or suspected drug/alcohol abuse
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00517062

Locations
United States, Oregon
Oregon Health and Science University
Portland, Oregon, United States, 97239
Sponsors and Collaborators
Oregon Health and Science University
Investigators
Principal Investigator: Jonathan Q. Purnell, MD Oregon Health and Science University
Principal Investigator: Charles T. Roberts, PhD Oregon Health and Science University
  More Information

Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Kevin Yuen, Principal Investigator, Oregon Health and Science University
ClinicalTrials.gov Identifier: NCT00517062     History of Changes
Other Study ID Numbers: IRB1844
Study First Received: August 15, 2007
Last Updated: May 2, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by Oregon Health and Science University:
Growth hormone
insulin sensitivity
cortisol

Additional relevant MeSH terms:
Dwarfism, Pituitary
Insulin Resistance
Bone Diseases
Bone Diseases, Developmental
Bone Diseases, Endocrine
Brain Diseases
Central Nervous System Diseases
Dwarfism
Endocrine System Diseases
Glucose Metabolism Disorders
Hyperinsulinism
Hypopituitarism
Hypothalamic Diseases
Metabolic Diseases
Musculoskeletal Diseases
Nervous System Diseases
Pituitary Diseases
Hormones
Insulin
Hormones, Hormone Substitutes, and Hormone Antagonists
Hypoglycemic Agents
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on November 23, 2014