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CYP3A4 change | Unpredictable trough levels | Major | Measure drug levels q1 to 2 wk during dose escalation | | Levothyroxine | Gastric emptying delay | Reduced Cmax ~30% | Moderate | Administer 60 min before any other oral drug

Defective hypothalamic autophagy and vesicular trafficking are also considered relevant pathogenic factors in the development of obesity 63,64

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Diabetologia 1990;33:675680

Estrogens play a major role in enhancing the GH response to GHSs at puberty, which GHRH hypoactivity, somatostatinergic hyperactivity and impaired activity of the putative GHS-like ligand and receptors probably explain the reduced GH-releasing effect of GHSs in aging