# Genryzon Pretreatment Screening > 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). - Skill: `dromlakhani/genryzon-pretreatment-screening` (Agent Skill) - Install (CLI): `npx skillmds@latest add dromlakhani/genryzon-pretreatment-screening` - Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/genryzon-pretreatment-screening/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: Marketing & Growth - Author: dromlakhani (https://skillmd.com/u/dromlakhani) - Updated: 2026-09-08 - Page: https://skillmd.com/skills/dromlakhani/genryzon-pretreatment-screening --- # Genryzon Pretreatment Screening Complete this checklist **BEFORE** the first Genryzon dose in a child with confirmed paediatric GHD. Missing any of these leads to preventable harm. --- ## Step 1 — Reconfirm the diagnosis of GHD Genryzon is indicated **only** for growth disturbance due to insufficient GH secretion. Before starting, verify: - **Two provocative GH stimulation tests** consistent with GHD (or one test + supportive auxology + low IGF-1/IGFBP-3 SDS + MRI evidence, per local guideline) - **Auxology consistent with GHD:** height SDS <−2, or height SDS <−1.5 with poor growth velocity, or drop in height percentile - **MRI pituitary** to identify structural cause (idiopathic vs organic; excludes intracranial tumour — see Step 5) - **Bone age** — for growth-potential assessment and later discontinuation planning **Do NOT start** in constitutional delay of growth and puberty (CDGP), familial short stature, or other non-GHD causes of short stature — Genryzon is not indicated and does not improve final height in these conditions. --- ## Step 2 — Thyroid function **Order:** TSH + free T4. **Why:** hypothyroidism blunts the response to growth hormone. Somatrogon can also unmask previously undiagnosed central hypothyroidism (GH increases T4→T3 conversion). **Action:** - **Pre-existing hypothyroidism → treat first.** Do not start Genryzon until euthyroid on levothyroxine - **Normal at baseline** → recheck TFTs at each 6–12 month review - **Consider central hypothyroidism** in any child with a hypothalamic/pituitary pathology on MRI — treat empirically per specialist judgement even if TSH looks "normal" --- ## Step 3 — Adrenal function **Why:** GH may unmask **central (secondary) hypoadrenalism**. Starting somatrogon in an unrecognised ACTH-deficient child risks adrenal crisis under stress. Additionally, GH decreases cortisone→cortisol conversion, so children already on glucocorticoid replacement may need dose escalation once GH is started. **Order:** - **Morning cortisol** (8 AM) — the entry-level test - If borderline or clinical suspicion → **ACTH stimulation test** or ITT per local protocol - If organic pituitary lesion / multiple pituitary hormone deficiency → **assume central hypoadrenalism** and start hydrocortisone replacement empirically **Action:** - **Any evidence of central hypoadrenalism → start hydrocortisone replacement BEFORE Genryzon**, and warn family about stress dosing / sick-day rules - **Already on glucocorticoid replacement → plan to review dose at 4–8 weeks** after starting Genryzon; often needs dose ↑ - **Normal adrenal axis at baseline** → still monitor for symptoms of adrenal insufficiency (fatigue, hypotension, hypoglycaemia) at each visit --- ## Step 4 — Glucose tolerance **Why:** GH reduces insulin sensitivity and can precipitate hyperglycaemia. Higher-risk children (family history of T2DM, obesity, high-risk ethnicity, previous glucocorticoid exposure, syndromic obesity) must be flagged. **Order:** - **Fasting plasma glucose + HbA1c** as baseline - **OGTT** if any risk factor or borderline FPG/HbA1c **Action:** - **Normal at baseline** → repeat FPG/HbA1c annually (more often if risk factors) - **Impaired fasting glucose / IGT / overt diabetes** → involve paediatric diabetologist; if starting Genryzon anyway, plan **more frequent glucose monitoring** and be prepared to **adjust insulin/OAD doses upwards** once GH is on board --- ## Step 5 — Tumour clearance **Why:** somatrogon is **contraindicated in active malignancy**. Children with prior CNS pathology require specific clearance. **Verify:** - **Any prior intracranial tumour must be inactive** — imaging within the recommended surveillance interval - **Antitumour therapy (surgery, radiation, chemotherapy) must be completed** before starting GH - **Childhood cancer survivors** — flag for elevated risk of **second neoplasm** on GH (especially meningioma after cranial radiation); document baseline surveillance plan - **No active malignancy anywhere** — check most recent oncology/imaging summary **Action:** - **Any suggestion of tumour activity → do not start.** Loop oncology in for clearance - **Cleared for GH** → document the clearance in the notes with date and imaging reference --- ## Step 6 — Baseline fundoscopy **Why:** benign intracranial hypertension (IH) with papilloedema, headache, vision changes, nausea/vomiting is a recognised somatrogon adverse event. A baseline fundus exam provides a comparator if IH is later suspected. **Order:** fundoscopy — by ophthalmology if available, or by trained clinician **Action:** - **Baseline documented** → refer to comparator if any later ocular / neurological symptoms - **Baseline abnormal** (papilloedema, unexplained disc changes) → do NOT start Genryzon; investigate the underlying cause --- ## Step 7 — Rule out Prader-Willi syndrome (or confirm it's PWS + GHD) **Why:** somatrogon has not been studied in PWS. Sudden death has been reported in PWS children on GH who have **severe obesity, upper airway obstruction, sleep apnoea, or unidentified respiratory infection**. Genryzon is **not indicated** for PWS-related growth failure unless the child also has confirmed GHD. **Action:** - **Suspected PWS features** (neonatal hypotonia, hyperphagia, hypogonadism, characteristic facies, obesity) → **do not start** until PWS is excluded by methylation testing / SNRPN analysis - **Confirmed PWS without confirmed GHD** → Genryzon not indicated. Refer to PWS specialist - **Confirmed PWS WITH confirmed GHD** → treatment may proceed but with: - Formal **sleep study** to exclude/quantify sleep apnoea before starting - **ENT review** if any upper airway concern - **Weight-management plan** and family counselling about respiratory risk - **Never start** during an intercurrent respiratory infection --- ## Step 8 — Baseline auxology and family readiness **Document at baseline:** - Standing height, weight, BMI, height SDS, weight SDS, mid-parental height SDS - Growth velocity from prior visits (cm/year) - Bone age (X-ray of left hand) - Tanner stage - Pubertal onset timing (age at breast bud / testicular volume 4 mL) **Confirm family is ready:** - Understand the diagnosis and expected duration of therapy - Can commit to a weekly injection routine (any day of week, any time of day, but same day each week) - Trained in pen technique, injection sites (abdomen / thighs / buttocks / upper arms), rotation, and disposal - **Caregiver assigned** for injections into upper arms or buttocks (child cannot self-inject those sites) - Knows what to do if a dose is missed (see the missed-dose rule) and what red-flag symptoms to escalate --- ## Guardrails - **Do not compress this checklist to "just check TFTs".** Adrenal, glucose, ocular, tumour, and PWS steps each block a specific harm - **Central hypoadrenalism can be occult** — a normal random cortisol does not exclude it. If any hypothalamic / pituitary structural lesion is present, err on the side of starting hydrocortisone replacement before GH and confirming with formal testing later - **A single normal FPG does not exclude glucose intolerance** — repeat at follow-up, and use HbA1c / OGTT in high-risk children - **Baseline fundoscopy** avoids the diagnostic dilemma of "was that papilloedema present before we started?" if IH is later suspected - **Do NOT start during any acute intercurrent illness** — acute critical illness (post open-heart / abdominal surgery, multiple trauma, acute respiratory failure) is an absolute contraindication - **Never start Genryzon in a child with active malignancy** — pause GH pending oncology clearance - **In female adolescents post-menarche**, consider whether OCP / other oral estrogen therapy is likely to be started — this influences later IGF-1 titration (see `genryzon-igf1-titration`) - **Document everything** — batch number of the first pen, all baseline values, all clearance letters. Growth hormone therapy is often audited --- ## Source Pfizer Products India Pvt. Ltd. **GENRYZON® (Somatrogon) Solution for Injection in Pre-filled Pen — Prescribing Information (India).** LPD version 2022-0081166 (PfLEET 2022-0081166). Sections 4.3 "Contraindications" and 4.4 "Special Warnings and Precautions for Use".