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Common Side Effects: Injection site reactions (erythema, pruritus, pain) Arthralgia (joint pain) Peripheral edema (fluid retention) Myalgia (muscle pain) Pain in extremities Important Warnings: Contraindicated in active malignancy: GH/IGF-1 promote cell proliferation Contraindicated in pregnancy: Category X Glucose monitoring required: May affect glucose metabolism IGF-1 monitoring recommended: To assess response and safety Rare but Serious: Potential tumor growth stimulation Glucose intolerance/diabetes exacerbation Hypersensitivity reactions Fluid retention complications Regulatory Status United States: FDA approved (2010) for HIV-associated lipodystrophy