| name | endo-therapeutic-goal-random-gh-1 |
| description | Suggests using a random GH level <1.0 µg/L as a therapeutic goal to assess biochemical control of acromegaly during follow‑up after surgery or medical therapy. Use when evaluating post‑treatment response, particularly when random GH is measured alongside IGF‑1 to determine if disease is controlled. |
Use random GH <1.0 µg/L as therapeutic goal
STEP 1 — Gather Information
Collect the patient's current random GH level, age‑adjusted IGF‑1, details of recent therapy (surgery, medical treatment), and presence of acromegaly‑related symptoms.
STEP 2 — Rule In / Rule Out
Is the random GH level <1.0 µg/L? If yes, proceed to step 3; if no, proceed to step 4 as inadequate control.
STEP 3 — Classify or Stratify
If random GH <1.0 µg/L and age‑adjusted IGF‑1 is within the laboratory‑specific normal range, classify as biochemical control; otherwise classify as inadequate control despite low GH.
STEP 4 — Decide
For biochemical control, continue current therapy and schedule re‑evaluation in 6–12 months; for inadequate control, consider intensifying therapy (e.g., dose adjustment of medical therapy, repeat surgery, or radiotherapy).
Clinical Guardrails / Mimics / Pitfalls
Do not rely on random GH alone for diagnosis (per guideline 1.4); avoid using a single GH measurement during acute illness or stress; ensure the same GH assay is used over time to minimize variability; do not ignore discordant IGF‑1 elevations or persistent symptoms.
Concrete Clinical Example
A 48‑year‑old man 3 months after transsphenoidal surgery has random GH 0.7 µg/L and age‑adjusted IGF‑1 within normal range; he is classified as controlled and continues clinical surveillance every 6 months.
Source: Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700
TODO: consider adding scripts/calc.py for the endo-therapeutic-goal-random-gh-1 calculator
