Progesterone Amplifies Estrogen-stimulated Growth Hormone Secretion in Older Women

Study Overview
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Brief Summary
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Progesterone amplifies estrogen-stimulated Growth Hormone (GH) secretion in postmenopausal women. Preliminary data are sought to estimate statistical power for more detailed studies of this hypothesis.

Detailed Description
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The systemic availability and orderly secretion patterns of GH and sex steroids decline in healthy aging men and women. The combined changes have substantial clinical implications to aging-related physical frailty, diminished aerobic capacity, sarcopenia, osteopenia, visceral adiposity, glucose intolerance, and reduced psychosocial wellbeing. Whereas androgen is considered the main trophic (anabolic) sex steroid, recent data demonstrate that certain tissues respond principally to GH and testosterone-derived estradiol, Estrogen (E2) (e.g. bone, brain, liver and pituitary). In principle, frailty may thus be associated with dual GH and sex-steroid deficiencies. Additionally, young, but not older healthy women secrete significant amounts of progesterone for approximately 14 days during the luteal phase of every menstrual cycle. When GH levels rise nearly two fold, the investigators hypothesize that progesterone potentiates the GH response to E2. This hypothesis arises from scattered indirect studies often using synthetic progestins with partial androgen agonism, instead of progesterone per se. Because there is no basis for estimating statistical power for this novel paradigm, 40 women, 10 each in 4 groups, will be studied. The pilot data will be used to calculate statistical power for a definitive R01-based investigation of gender-specific distinctions in estrogen-regulated pituitary-hormone secretion.

Official Title
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Progesterone Amplifies Estrogen-stimulated Growth Hormone Secretion in Older Women

Conditions
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Healthy

Intervention / Treatment
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* Drug: IM Saline Placebo (0.25 ml)
* Drug: IM Estradiol valerate (2.5 mg)
* Drug: IM Saline Placebo (0.5 ml)
* Drug: IM Estradiol valerate (5.0 mg)
* Drug: Oral Micronized Progesterone
* Drug: Oral Placebo
* Drug: Ghrelin (0.3 ug/kg)
* Drug: Medroxyprogesterone - Acetate
* Drug: Oral Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: women ages 50 to 80 postmenopausal as defined by: any combination of the following Hormonally postmenopausal for 1 year Lh greater than 15 IU/L, FSH greater than 30 IU/L Total hysterectomy with oophorectomy greater than one year Hysterectomy with ovaries preserved with hormone levels: Lh > 15 IU/L, FSH > 30 IU/L Following laboratory results with normal range, unless PI approves out of range values. BMI 18 to 35 Exclusion Criteria: structural hypothalamo-pituitary-gonadal disease endocrinopathy (diseases involving the following organs pituitary, thyroid, adrenals, ovaries, testes and pancreas), other than primary thyroid failure receiving replacement recent (within 2 weeks) estrogen, progestin, anabolic steroid or glucocorticoid use clinically significant ECG abnormality as determined by study team physicians obstructive uropathy history of a stroke history of MI or angina acute or chronic systemic disease recent transmeridian travel (traversing more than 3 time zones within 7 days of admission) current night shift work concurrent use of neuropsychiatric medications alcohol or drug abuse, current and within 2 years history of depression, psychosis, or mania weight gain or loss (2 kg or more in 3 weeks) BMI > 35 kg/m2 anemia, hemoglobin less than 12.5 g/dl abnormal hepatorenal function, creatinine outside normal range, ALT greater than two times normal range biochemical and chemistry lab results out of physician acceptable range history of deep-vein thrombophlebitis history of Congestive Heart Failure, cardiac arrhythmias, and medications used to treat cardiac arrhythmias known allergy to estradiol valerate, castor oil or sesame oil history of smoking within the last 2 years untreated gall bladder disease lack of voluntary, written informed consent history of carcinoma excluding localized basal cell or squamous cell, including women with known, suspected or history of breast cancer not clinically postmenopausal women with allergies to nuts will not be enrolled in the study.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: IM Plac - Oral Plac - Ghrelin<br>Day 1: IM Saline Placebo (0.25 ml) Day 10: IM Saline Placebo (0.5 ml) and Oral Placebo 3x/day Day 23: IV push of ghrelin (0.3 ug/kg) + Placebo (for 10 days) | Drug: IM Saline Placebo (0.25 ml)<br> <br> Drug: IM Saline Placebo (0.5 ml)<br> <br> Drug: Oral Placebo<br> <br> Drug: Ghrelin (0.3 ug/kg)<br> <br> Drug: Oral Placebo<br>* (in lieu of Medroxyprogesterone)<br>|
| Experimental: IM Plac - Oral Prog - Ghrelin<br>Day 1: IM Saline Placebo (0.25 ml) Day 10: IM Saline Placebo (0.5 ml) and Oral Micronized Progesterone 3x/day Day 23: IV push of ghrelin (0.3 ug/kg) + Placebo (for 10 days) | Drug: IM Saline Placebo (0.25 ml)<br> <br> Drug: IM Saline Placebo (0.5 ml)<br> <br> Drug: Oral Micronized Progesterone<br> <br> Drug: Ghrelin (0.3 ug/kg)<br> <br> Drug: Oral Placebo<br>* (in lieu of Medroxyprogesterone)<br>|
| Experimental: IM E2 - Oral Plac - Ghrelin<br>Day 1: IM Estradiol (2.5 mg) Day 10: IM Estradiol (5.0 mg) and Oral Placebo 3x/day Day 23: IV push of ghrelin (0.3 ug/kg) + Medroxyprogesterone (5 mg - for 10 days) | Drug: IM Estradiol valerate (2.5 mg)<br> <br> Drug: IM Estradiol valerate (5.0 mg)<br> <br> Drug: Oral Placebo<br> <br> Drug: Ghrelin (0.3 ug/kg)<br> <br> Drug: Medroxyprogesterone - Acetate<br> <br> |
| Experimental: IM E2 - Oral Prog - Ghrelin<br>Day 1: IM Estradiol (2.5 mg) Day 10: IM Estradiol (5.0 mg) and Oral Micronized Progesterone 3x/day Day 23: IV push of ghrelin (0.3 ug/kg) + Placebo (for 10 days) | Drug: IM Estradiol valerate (2.5 mg)<br> <br> Drug: IM Estradiol valerate (5.0 mg)<br> <br> Drug: Oral Micronized Progesterone<br> <br> Drug: Ghrelin (0.3 ug/kg)<br> <br> Drug: Oral Placebo<br>* (in lieu of Medroxyprogesterone)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Logarithm of the ratio of the normalized growth hormone secretion rate over the first 10 hr. | Subjects will be given IM placebo/estradiol on Day 1. 10 days later they will receive IM placebo/estradiol again, then start progesterone/placebo capsules for 14 days. On Day 23, subjects will undergo a 12-h overnight (2200 - 1000h) fasting, 10-min blood sampling. The primary comparison parameter is the logarithm of the ratio of the normalized growth hormone secretion rate over the first 10 hr. | The subject will be followed on average for a month. Growth hormone measurements will occur on Day 23 after initiation of study drug administration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Growth hormone secretion post ghrelin injection | Subjects will be given IM placebo/estradiol on Day 1. 10 days later they will receive IM placebo/estradiol again, then start progesterone/placebo capsules for 14 days. On Day 23, subjects will undergo a 12-h overnight (2200 - 1000h) fasting, 10-min blood sampling. A secondary outcome is GH secretion over the 2 hr after bolus ghrelin injection, a potent growth hormone secretagogue | The subject will be followed on average for a month. Growth hormone measurements will occur on Day 23 after initiation of study drug administration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Normal Healthy Volunteers