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Baseline and periodic monitoring should include: Serum IGF-1 (target: mid-normal for age) Fasting glucose and HbA1c (GH antagonizes insulin action) [18] Lipid panel Assessment for fluid retention, arthralgias, and carpal tunnel symptoms The American Association of Clinical Endocrinology advises against GH-axis therapy in patients with active malignancy or uncontrolled diabetes [12]

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