Metoclopramide induced growth hormone release in hypogonadal males

Clinical and pharmacological characterization of anomalous metoclopramide-induced growth hormone secretion in insulin-dependent diabetes mellitus

An abnormal growth hormone (GH) increase after non-specific stimuli (such as TRH, LHRH and, in a few cases, metoclopramide), has been described in insulin-dependent diabetes. Sixty-nine non-hypogonadic male insulin-dependent diabetic patients (mean age 38.6 years, range 18-54; mean duration of diabetes 11.1 years, range 1.3-28, in different degree of metabolic control, some of them with retinopathy, nephropathy and peripheral and/or autonomic neuropathy) were tested twice with 10 mg i.v. metoclopramide (MCP), an antidopaminergic agent with weak serotoninergic activity. Anomalous GH response (i.e. GH increment equal to or higher than 5 ng/ml from basal level) occurred in 33 patients (47.8%). Mean (+/- SE) MCP-induced GH release in these 'responder' patients peaked up to 17.2 +/- 1.7 ng/ml in comparison with no variation found in 'non-responders' and in 25 healthy control men. Abnormal GH secretion appeared to be unrelated to age, metabolic control, basal GH values and duration of diabetes. Moreover, it remained unmodified by pretreatments with placebo, cimetidine, meclastine, propranolol, acetylsalicylic acid and naloxone, while it was enhanced by metergoline, significantly reduced by bromocriptine and almost completely blunted by pirenzepine, a cholinergic muscarinic receptor antagonist. Neuropathy and nephropathy were equally distributed in the two groups, while retinopathy was more frequent in 'responders'. In conclusion, the exact mechanism(s) by which MCP may induce a paradoxical GH release in many insulin-dependent diabetic patients, is still unclear; it might be dependent, at least in part, on the activation of cholinergic pathways. Indeed, it seems to indicate the presence, in diabetes, of a rather complex derangement in the regulatory mechanisms of GH secretion.

Effect of metoclopramide on serum growth hormone levels in cirrhotic men

Growth hormone (GH) secretory response to metoclopramide (MCP) administration was evaluated in 9 male patients with liver cirrhosis and in 6 normal controls. As expected, MCP did not modify serum GH concentrations in normal subjects. In contrast, a striking GH secretory response to MCP was observed in 5 out of 9 cirrhotics. In the other four patients serum GH levels did not show any variation after MCP. The different behavior between cirrhotic "responders" and "non responders" can not be interpreted on the basis of the medical history or the clinical and laboratory data. Three hypothesis are proposed: i) The effect of MCP could be promoted by estrogens and inhibited by androgens. ii) False neurochemical transmitters could affect dopaminergic system of some cirrhotics, allowing or inhibiting the GH response to MCP. iii) MCP could stimulate GH secretion by a serotonergic mechanism. These findings provide further evidence of a modification of the GH secretory pattern in patients with cirrhosis of the liver.

Cholinergic and histaminergic involvement in the growth hormone releasing effect of an enkephalin analog FK 33-824 in man

Studies were performed in healthy subjects to ascertain the neurotransmitter systems involved in the growth hormone (GH)-releasing effect of the potent enkephalin analog FK 33-824. Concomitant evaluation of prolactin (PRL) secretion was also performed in the same subjects. FK 33-824 at a dose of 0.5 mg IV elicited a clear-cut rise in plasma GH and PRL concentrations with peak levels at 45 min. Blockade of muscarinic cholinergic receptors by atropine (0.5 mg SC) or histaminergic H1 receptors by diphenhydramine (50 mg IV bolus plus 50 mg infusion) completely suppressed the GH release induced by FK 33-824, without significantly altering the PRL rise induced by the peptide. Pretreatment with the alpha-adrenergic antagonist phentolamine (0.5 mg IV/min for 120 min) or the dopamine receptor blocker metoclopramide (10 mg IV) did not alter the GH-releasing effect of FK 33-824. Phentolamine failed to alter the PRL rise induced by FK 33-824, while combined FK 33-824-metoclopramide administration induced a greater PRL increase than FK 33-824 alone. These results indicate that cholinergic and histaminergic H1 receptors play an important role in the GH-release induced by FK 33-824 in man, whereas this action seems to occur independently of catecholaminergic mediation. The same receptors are not involved in the PRL-releasing effect of the peptide.

The effects of arginine, insulin and metoclopramide on growth hormone, prolactin and cortisol release in children

The growth hormone (GH) and prolactin (PRL) responses to metoclopramide (MCP) were compared to those with arginine and insulin-induced hypoglycaemia in eight children. While a significant rise in GH release after stimulation with arginine and insulin occurred in all subjects (P less than 0.05), no significant increase after MCP ingestion was observed. Metoclopramide, a dopamine antagonist, stimulated PRL release in all children, while arginine and insulin-induced hypoglycaemia stimulation tests showed variable PRL responses. A statistically significant increase in cortisol secretion 5 h following MCP was observed (trend test, Cox & Stuart, 1955) (P less than 0.05), but the plasma concentration at this time was still within the normal range. Metoclopramide stimulation is not a suitable test for growth hormone deficiency in children.

Metoclopramide stimulation: a test of growth hormone reserve in adolescent males

A comparison was made between the growth hormone (GH) response to metoclopramide ('Maxolon'--Beecham Laboratories) and insulin induced hypoglycaemia in thirty-five short adolescent males. Both tests initially caused adequate release of GH from the pituitary gland in 86% of those subjects who had normal GH reserve. The peak growth hormone responses of the two tests were similar in magnitude and were strongly correlated (r = 0.80, P less than 0.001). Both tests raised serum GH to a similar degree in twenty-nine out of the thirty-five boys (83%), but four boys who responded satisfactorily to hypoglycaemia failed to respond to metoclopramide (MCP) stimulation, and two boys who failed to respond to hypoglycaemia responded satisfactorily to MCP stimulation. MCP stimulation does not require prior preparation of the patient and is relatively free of side effects. Consequently, it is suggested that MCP stimulation may be a useful 1 hour out-patient test for growth hormone deficiency in this relatively common group of patients.