e. height and IGF-1 less than or equal to −3 SDS, normal GH secretion, after LY3009104 manufacturer poor compliance with scheduled GH injections has been ruled

out). In cases where compliance is a question, the recombinant human GH (rhGH) should be administered by a reliable RG7112 in vitro source. 3 The IGF-1 Generation Test The principle behind the design of the IGF-1 Generation Test (IGFGT) was that repeated injections of human GH induce measurable increases in IGF-1, IGFBP-3 and ALS secretion. However, in GH-deficient patients, the degree of IGF-1 response did not convincingly predict the growth response to GH therapy [13]. Because of this, the IGFGT is primarily a research tool. Performing the IGFGT is not necessary to make a diagnosis of SPIGFD, nor should it be required to begin mecasermin replacement; meeting the less than or equal to −3 height and IGF-1 SDS criteria in the setting of normal-to-high GH is sufficient to make the diagnosis of SPIGFD. 4 Treatment 4.1 IGF-1 (Mecasermin rDNA) Administration Once a diagnosis of SPIGFD has been made, it is important to begin treatment with mecasermin as soon as possible. Growth rates are highest during the first year of treatment [6], and both first-year catch-up growth

and long-term outcomes, such as adult height, are better when therapy is initiated in younger children at an appropriate dose [10, 14]. Treatment with mecasermin involves twice-daily SCH727965 injections [6], ideally over a period of years to maximize adult height, and compliance is crucial to achieve both optimal growth outcomes and safety.

In our practices, treatment therefore begins with extensive family discussions. 4.2 Side Effects Patients and caregivers must be familiar with all the risks and benefits of treatment, especially with regard to common side effects of mecasermin, including symptoms of hypoglycemia. The most common side effects of mecasermin therapy are listed below [6]. Hypoglycemia is often present before treatment in patients with SPIGFD, particularly young children with the phenotype of Laron syndrome [15]. Treatment Sitaxentan with mecasermin may exacerbate this, especially during the early stages of therapy. Information about the occurrence of hypoglycemia should be sought even before beginning mecasermin. The dose of mecasermin should be increased more slowly in children with a prior history of hypoglycemia. Younger patients, who may have difficulty articulating symptoms, should be monitored carefully during the treatment initiation phase. Hypoglycemic episodes are minimized through adequate carbohydrate (or caloric) intake along with each injection and by avoiding overdose; we advise administration within 20 min of a meal or snack [6], and provide training in dose calculation and delivery.