Growth Hormone Replacement Therapy Monitoring

Introduction to Monitoring

The American College of Endocrinology recommends regular monitoring of specific clinical and laboratory parameters for patients on growth hormone replacement therapy to ensure safety and efficacy, including growth and development, metabolic parameters, renal function, and treatment response 1

Monitoring of stature/height, height velocity (particularly important in first year of treatment), pubertal development, and skeletal maturation (wrist radiography) is essential for patients on growth hormone replacement therapy 1
If height velocity in first year is less than 2 cm/year over baseline, assessment of adherence to therapy, measurement of serum IGF-1 levels, review of weight-adjusted GH dosage, and evaluation of nutritional and metabolic factors are recommended 1

Monitoring of fasting blood glucose, insulin levels, thyroid function (TSH and free T3), calcium and phosphate levels, bicarbonate levels, and parathyroid hormone (PTH) levels is crucial for patients on growth hormone replacement therapy 1
Growth hormone may stimulate parathyroid gland activity, and monitoring of calcium, phosphate, and PTH levels is necessary, with consideration of discontinuing GH if PTH >500 pg/ml 1

Monitoring of eGFR (estimated glomerular filtration rate) and watching for unexplained decreases in renal function are important for patients on growth hormone replacement therapy 1
Unexplained decrease in eGFR is a reason for discontinuation of GH replacement therapy 1

Monitoring of serum insulin-like growth factor 1 (IGF-1) levels and weight-adjusted GH dosage assessment are necessary to evaluate treatment response 1

More frequent monitoring is recommended for young patients, patients with advanced CKD, and during initial months of therapy (when dose adjustments are common), with a standard interval of every 3-6 months 1
Baseline fundoscopy before initiating GH therapy and immediate evaluation including fundoscopy if persistent headache or vomiting occurs are recommended 1
Watching for symptoms of slipped capital femoral epiphysis and obtaining bone radiographs if symptoms occur is necessary 1
Discontinuation of GH replacement therapy is recommended in cases of epiphyseal closure, persistent severe secondary hyperparathyroidism (PTH >500 pg/ml), intracranial hypertension, slipped capital femoral epiphysis, inadequate response despite optimal management, accelerated bone maturation, or unexplained decrease in eGFR 1