IGF-I within normal range
Improvement of symptoms
Fig. 1 Decision process for assessing the appropriateness of replacement therapy with rhGH using IGF-I assessment.
Any side effets?
Reduce rhGH dose Reduce rhGH dose
Increase rhGH dose
Continue with the same rhGH dose and check IGF-I levels every 6 months
YES NO (below normal range)
NO (above normal range)
YES YES
NO