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Suggests adjusting glucocorticoid dose according to severity of illness or magnitude of the stressor in patients with primary adrenal insufficiency. Use when patient with PAI has intercurrent illness, fever, or stress.
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SOC 職業分類に基づく
Drug-interaction and co-medication adjustment reference for a child on Genryzon (somatrogon, weekly long-acting growth hormone). Covers glucocorticoids, insulin and oral hypoglycaemics, thyroxine, oral estrogen, and CYP3A4-metabolised drugs (sex steroids, corticosteroids, anticonvulsants, ciclosporin). Use when a clinician asks about drug interactions with Genryzon or somatrogon, prescribing another drug in a child on GH, girl on Genryzon starting OCP, diabetic child starting GH, adjusting hydrocortisone on GH, or CYP3A4 concerns with somatrogon. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Titrate Genryzon (somatrogon, weekly long-acting growth hormone) dose in a paediatric GHD patient using serum IGF-1 SDS. Encodes the mandatory 4-days-post-dose sampling rule, the target SDS window, the 15% dose-reduction trigger, and the oral estrogen adjustment. Use when a clinician asks how to titrate somatrogon, when to sample IGF-1 on Genryzon, target IGF-1 SDS on weekly GH, what to do if IGF-1 is too high on somatrogon, IGF-1 rising on Genryzon, how to adjust GH dose in a girl started on oral OCP, or presents a paediatric GHD case on somatrogon with an IGF-1 value to interpret. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Bedside prescribing reference for Genryzon (somatrogon, Pfizer India) — the once-weekly long-acting growth hormone for paediatric growth hormone deficiency. Use when a clinician asks how to start Genryzon, how to dose somatrogon in a child, how to switch a child from daily growth hormone to weekly somatrogon, how to inject the Genryzon pen, missed-dose rule for somatrogon, when to stop somatrogon, or needs a monograph-level prescribing decision for a paediatric GHD patient. Applies to children and adolescents ≥3 years of age. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Pretreatment screening checklist before starting Genryzon (somatrogon, weekly long-acting growth hormone) in a child with confirmed paediatric growth hormone deficiency. Ensures thyroid, adrenal, glucose, ocular, tumour, and Prader-Willi status are checked before the first dose to prevent adrenal crisis, wasted therapy, unmasked hypothyroidism, unrecognised hyperglycaemia, missed intracranial hypertension, or sudden death in PWS. Use when a clinician asks what to check before starting somatrogon, workup before Genryzon, baseline tests for weekly GH, screening for adrenal insufficiency before GH, or is about to prescribe Genryzon in a paediatric GHD case. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Red-flag safety scan for a child on Genryzon (somatrogon, weekly long-acting growth hormone) — recognise and act on the treatment-emergent adverse events that require holding, investigating, or stopping the drug. Covers benign intracranial hypertension, slipped capital femoral epiphysis, pancreatitis, injection-site myositis (m-cresol), scoliosis progression, second neoplasm surveillance in cancer survivors, hyperglycaemia unmasking, and adrenal insufficiency unmasking. Use when a clinician asks what side effects to watch for on Genryzon, red flags on weekly GH, headache in a child on somatrogon, limp in a child on GH, abdominal pain on Genryzon, or is following up a paediatric GHD patient on somatrogon. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
Decide when to stop Genryzon (somatrogon, weekly long-acting growth hormone) in a paediatric GHD patient — the three physiological gates (epiphyseal closure, height velocity <2 cm/year, bone age >14 in girls or >16 in boys) plus the safety-driven stops (active tumour, adult GHD re-evaluation, adverse events). Use when a clinician asks when to stop somatrogon, when to discontinue Genryzon, is the child done with GH, has this child reached final height on GH, transitioning GH from paediatric to adult care, or is reviewing a teenager who has been on Genryzon for years. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
| name | enda-adjust-glucocorticoid-stress-illness |
| description | Suggests adjusting glucocorticoid dose according to severity of illness or magnitude of the stressor in patients with primary adrenal insufficiency. Use when patient with PAI has intercurrent illness, fever, or stress. |
Assess for intercurrent illness, fever, inability to tolerate oral meds, upcoming surgery/trauma/delivery, or other stressors; record temperature, need for bedrest, antibiotics, vomiting, fasting, surgical type, and ability to retain oral medication.
Determine if stressor warrants glucocorticoid dose increase: fever ≥38°C, illness requiring bedrest/antibiotics, vomiting/trauma preventing oral intake, minor/moderate/major surgical stress, or delivery; if none, continue usual dose.
Classify stressor magnitude:
Administer the selected glucocorticoid regimen; if oral route possible, give divided doses with largest dose in morning; if parenteral, start with bolus then continuous infusion; reassess after 24h and taper to maintenance as clinical improvement occurs.
Do not delay stress dosing while awaiting diagnostic results; avoid dexamethasone for stress dosing due to lack of mineralocorticoid activity and risk of adrenal crisis; do not underdose in hypotension or shock; ensure fluid resuscitation with isotonic saline and dextrose; do not rely on ACTH or cortisol levels to adjust stress doses.
A 45‑year‑old woman with PAI presents with fever 39.5°C and productive cough; she doubles her usual hydrocortisone dose (e.g., from 20 mg AM/10 mg noon to 40 mg AM/20 mg noon) and continues until afebrile 24h later, then tapers back to maintenance.
Source: Diagnosis and Treatment of Primary Adrenal Insufficiency, Endocrine Society, 2016, DOI: 10.1210/jc.2015-1710
