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Adults with growth hormone (GH) deficiency can be divided into two groups: those who were GH-deficient as children and continue to be so as adults (childhood-onset AGHD), and adults with pituitary disease who became GH-deficient as adults (adult-onset AGHD).

It isn’t always easy to find accurate information on your own: that’s why it’s important to tell your doctor about your concerns and find out if there’s a medical issue.

Your journey might begin like this:

• You recognize that something may be wrong, and ask your doctor about it
• Your doctor takes a closer look
• Your doctor refers you to a specialist for testing
• If the doctor decides it’s needed, you get a prescription for GH therapy

How you can take action:

Follow up with your doctor

If you have a number of these symptoms, it may mean it’s time to have a discussion with your healthcare professional. Print the list out and bring it along on your doctor visit. You can also use the Doctor Discussion Guide.

If there’s a medical issue, take steps now

If your doctor suspects there’s a medical issue, he or she may refer you to a specialist for testing. Testing can take time—but it’s important.

• You may need to see an endocrinologist or other specialist for a clinical assessment—an evaluation based on a physical exam, lab work, and the patient’s medical history
• Tests are necessary to see if there is a problem
• The tests can take time—and patience—to get through
• At this stage, tests may include:
  • Baseline tests that assess body fat and muscle mass, cholesterol levels, and spine bone mineral density (BMD)
  • A DEXA scan, which uses X-rays at two different energy levels to scan your body
  • Skin fold thickness
  • Body mass index (BMI)
  • Lab tests

Your doctor may review the test results and discuss treatment options. You can also use the time to get your questions answered. Ask your doctor or nurse about:

• What your test results mean
• What to expect
• Will there be any upcoming lab work or other tests? When?
• How long it may take to get test results
• Will my dose of Nutropin change over time?
• How can I deal with disruptions to my schedule and take Nutropin every day, as prescribed?
• Is there an alternative to injection with vial and syringe?
• How might the GH help me?
• Where can I find reliable information about GH?
• How well do you think I’m doing, overall?
• Are there any additional steps I can take to improve my experience with therapy?
• Can you please tell me about the possible side effects?
• Do I have childhood-onset AGHD or adult-onset AGHD? What is the difference?

Some other issues you may want to ask about:

• Why do I need to give myself an injection every day?
• How do I give myself the injection? How do I know I’m doing it right?
• How does GH therapy work?
• How can I evaluate my own progress between visits?

IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol, an ingredient in the liquid used to mix Nutropin Injection. Sterile water should be used when mixing Nutropin for newborns.

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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