Adipose Tissue and Circulating Markers of Inflammation in GH Deficiency and Changes With GH Therapy

The growth hormone (GH) axis has important influences on adipose tissue. GH may have a novel
effect to reduce macrophage yet increase adipocyte inflammation in adipose tissue along with
reducing adipose tissue mass. Disordered adipose tissue metabolism may dysregulate adipokine
secretion, which could contribute to metabolic abnormalities in GH deficiency. Adipokines,
peptides expressed and secreted by adipose tissue, exert important local adipose tissue and
systemic metabolic effects. This study will combine direct assessment of adipose tissue with
assessment of body composition. Adult GHD can be associated with central adiposity, insulin
resistance, dyslipidemia and increased cardiovascular (CV) risk.

Inclusion criteria:

1. Males or females age ≥18 years with diagnosis of GH deficiency that is Adult Onset,
either alone or associated with multiple pituitary hormone deficiencies and due to
pituitary disease,hypothalamic disease, surgery, radiation therapy or Childhood Onset
due to congenital, genetic, acquired, or idiopathic causes.

2. Diagnosis of GH deficiency defined by: insulin tolerance test or glucagon test: peak
GH response < 3 ng/ml or 3 or more pituitary hormone deficiencies and insulin-like
growth factor 1 (IGF-1) standard deviation score < -2.0

3. No history of diabetes mellitus and fasting blood sugar at screening visit ≤ 120
mg/dl.

4. If patients have undergone surgical resection of a pituitary adenoma, a minimum of 12
months must have elapsed post surgery prior to enrollment and tumor will be
demonstrated to be unchanged for 12 months or longer since surgery.

5. May have a history of radiotherapy, but they must have completed their course of
radiotherapy more than 3 months prior to study screening.

6. If prior GH therapy must have not received prior GH replacement therapy in 310 the 6
months prior to screening.

7. Stable pituitary hormone supplements (x 3 months) prior to baseline visit and normal
levels of free thyroxine, testosterone in males and normal adrenal function if not on
replacement therapy.

8. If female, a. Not pregnant (as evidenced by a negative serum pregnancy test) or
lactating and b. If of childbearing potential, agrees to use a medically acceptable
form of contraception (such as oral, implantable, or barrier contraception) from the
time of screening, for the duration of the study, and for at least one month after
study discontinuation or completion. Childbearing potential is defined as women who
are not surgically sterile or not at least one year postmenopausal.

9. Sign and date an informed consent document indicating that the subject (or legally
acceptable representative) has been informed of and agrees to all pertinent aspects of
the trial.

Exclusion Criteria:

1. Have other conditions that may result in abnormal GH and/or IGF-I concentrations
(e.g., severe hepatic disease, severe renal disease, malnutrition, treatment with
levodopa).

2. Alanine aminotransferase (ALT) or aspartate transaminase (AST) ≥ 2 x upper limit of
normal or clinically significant hepatic disease or renal impairment defined as
creatinine > 1.5x upper normal.

3. Have a pituitary adenoma with a distance to the optic chiasm of 5 mm or less,
confirmed by a recent MRI scan (within two months prior to the screening visit).

4. Pituitary tumor growth within the 12 months prior to study entry.

5. GH therapy within 6 months of screening.

6. Diabetes mellitus.

7. History of acromegaly.

8. History of active Cushing's disease within 24 months of screening

9. Visual field defects or other neurological symptoms due to current tumor mass
compression.

10. Have known or suspected drug or alcohol abuse.

11. Have received an investigational medication within four weeks prior to Screening or is
scheduled to receive any investigational medication during the study.

12. Do not have the ability to fully comprehend the nature of the study, to follow
instructions, cooperate with study procedures, and/or are unable to adhere to the
visit scheduled outlined in the protocol.

13. Have other severe acute or chronic medical or psychiatric condition or laboratory
abnormality that may increase the risk associated with study participation or study
drug administration or may interfere with the interpretation of study results and, in
the judgment of the investigator, would make the subject inappropriate for entry into
this study.

14. History of a malignancy other than squamous or basal cell skin carcinoma that has been
excised or intracranial malignant tumors or leukemia within 5 years of screening.

15. Patients who have a known hypersensitivity to GH therapy

16. Use of weight 349 loss medications

17. Females who plan to change estrogen therapy during the trial

18. Patients who have received supraphysiologic doses of glucocorticoids within the past 6
months (except for peri-operative (< 3 days duration) of dexamethasone), or who are
currently receiving any chemotherapeutic agents.

19. Patients who have received other investigational drugs administered or received within
30 days of study entry