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Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
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| name | ata-gh-titration |
| description | Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment. |
Collect current GH dose (mg/d), age-adjusted IGF-1 level and its upper limit of normal (ULN), and assess for GH-related side effects (fluid retention, arthralgia, myalgia, paresthesia, carpal tunnel syndrome, sleep apnea, etc.). Record IGF-1 as % above/below ULN and side-effect presence/severity.
Is the IGF-1 level above the age-adjusted ULN? If yes, proceed to dose-reduction evaluation; if no, assess for side effects to determine if dose reduction is warranted.
Classify IGF-1 elevation: mild (1–25% above ULN), moderate (26–50% above), severe (>50% above). If IGF-1 ≤ ULN, classify side-effect severity: none, mild, moderate/severe.
If IGF-1 > ULN, reduce GH dose by 0.1–0.2 mg/d for mild, 0.2–0.3 mg/d for moderate, ≥0.3 mg/d for severe; if side effects present, reduce dose by 0.1–0.2 mg/d for mild, 0.2–0.4 mg/d for moderate/severe; recheck IGF-1 and side effects in 6 weeks. If IGF-1 ≤ ULN and no side effects, consider maintaining dose or increasing by 0.1 mg/d if clinically indicated and IGF-1 remains below ULN.
Do not titrate GH dose based solely on IGF-1 without assessing side effects; avoid exceeding dose that causes adverse effects such as significant fluid retention or hyperglycemia; do not use GH in patients with active malignancy or uncontrolled diabetes; do not ignore age-adjusted IGF-1 reference ranges; do not increase dose when IGF-1 is already at or above ULN; do not forget to assess for pituitary tumor recurrence in long-term therapy.
A 45-year-old woman on GH replacement 0.3 mg/d has IGF-1 at 130% of age-adjusted ULN and mild ankle swelling. Dose reduced by 0.2 mg/d to 0.1 mg/d; after 6 weeks IGF-1 falls to 110% ULN and swelling resolves; dose held.
Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118
TODO: consider adding scripts/calc.py for the ata-gh-titration calculator