Growth Hormone Deficiency: Optimizing IGF-I Monitoring for GH Therapy

1. Welcome to a new accredited tweetorial on Growth Hormone Deficiency in anticipation of our GHD Academy going live on March 19th in collaboration with the wonderful Human Growth Foundation. This tweetorial provides 0.25 AMA PRA Category 1 Credits. #CME.

2. Statement of accreditation and disclosures can be found at https://app.medall.org/c/medall-endocrinology/resources/cme-growth-disorders. This program has been supported by an independent medical education grant from Novo Nordisk and is delivered in joint providership with AffinityCE

3. 🧵 So . . .Why individualized IGF-I monitoring? 🤔 Monitoring IGF-I levels is critical to optimizing daily and long-acting GH (LAGH) therapy. Let’s explore how timing and adjustments ensure safety and efficacy. #GHD #EndoTwitter

4. 📊 IGF-I Monitoring: Daily vs. Weekly GH ✔️ Daily GH: IGF-I stable, measure any time ✔️ LAGH: Fluctuations occur (peak/trough) Precise timing critical (Day 4-5 post-injection ideal).

5. 🔍 Timing Matters with LAGH: Incorrect timing = misleading IGF-I results! ✔️ Ideal sampling window: Lonapegsomatropin (Day 4.5), Somapacitan/Somatrogon (Day 4) ✔️ Use correction factors if sampled outside ideal windows.

6. 📌 Practical Application: IGF-I Correction Factors ✔️ Lonapegsomatropin: Day 4.5 optimal ✔️ Somapacitan & Somatrogon: Day 4 optimal Use these correction factors to adjust doses correctly.

7. 🎯 Tailoring GH Therapy: ✔️ High IGF-I levels (> +2 SDS): consider dose reduction ✔️ Low IGF-I (< -2 SDS): consider dose increase

8. ⚠️ Special Populations & Monitoring: Extra caution needed for: ✔️ Hypoglycemia risk (severe GHD) ✔️ History of cancer ✔️ Adolescents with complex medical or adherence challenges Careful individualized approach ensures safety and efficacy.

9. 📋 Long-Term Surveillance: ✔️ Monitor via registries (e.g., @GloBE_Reg, REAL7/10, SkyPASS) ✔️ Track safety, adherence, QoL, long-term metabolic/cardiovascular effects ✔️ Data-driven adjustments enhance long-term outcomes.

10. 🗣️ Effective Communication: Clearly communicate: ✔️ Importance of timely IGF-I monitoring ✔️ Potential side effects and realistic expectations ✔️ Benefits of adherence and proactive adjustments Better communication = better patient outcomes!

11. 🎯 Key Takeaway: Tailored IGF-I monitoring, precise timing, and data-driven dose adjustments are crucial for optimizing GH therapy outcomes. Education and clear communication ensure long-term success. Join our live discussion on March 19th for more! #MedicalEducation #EndoTwitter

Thank you for participating in this tweetorial! We hope you are as excited about the future of #GHD as we are! Claim your FREE credit NOW at https://medall.org/GHDtweetorial3 and follow us for more CE/#CME!

6. ⚠️ Practical considerations in LAGH dosing: ✔️ Higher dose: younger patients, women on oral estrogen ✔️ Lower dose: older patients, obesity, diabetes risk ✔️ Avoid in severe liver impairment, active malignancy Tailored dosing optimizes outcomes & minimizes risk.

6. ⚖️ Communication is Key: Clear, patient-centered discussions improve adherence & outcomes: ✔️ Set realistic expectations ✔️ Address fears & misconceptions about GH therapy ✔️ Highlight treatment benefits clearly

7. 🚨 Pitfalls & Precautions: Be cautious: ✔️ Limited data in cancer survivors & patients with residual tumors ✔️ Higher risk populations need individual assessment

8. 📈 Monitoring LAGH Therapy: Assess regularly: ✔️ IGF-I levels (use correction factors) ✔️ Clinical efficacy (growth, metabolic parameters) ✔️ Adverse effects, comorbidities

9. 📌 Key Takeaways: Transitioning from daily GH to LAGH can boost adherence and QoL. Patient selection, careful monitoring, and open communication are essential for success.

10. 🔗 Join our live session on March 19th for deeper insights! What’s your biggest challenge in transitioning patients? Let’s discuss! #MedEd #EndoTwitter

Thank you for participating in this tweetorial! We hope you are as excited about the future of #GHD as we are! Claim your FREE credit NOW at https://medall.org/GHDtweetorial2 and follow us for more CE/#CME!