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The Ecuadorian Laron and Brazilian Itabaianinha cohorts with congenital mutations in the GH and GHRH receptors, respectively, both provide a unique and arguably the purest examples to evaluate the effects of chronic severe IGF-I and both severe GH and IGF-I deficiency, respectively, with severe hypoinsulinemia being the common denominator in both cohorts (151, 152) ( Table 1

Multi-dose vials: Each needle puncture creates potential entry point for contaminants After 10-15 punctures, seal integrity weakens Recommendation: Use vial within 28 days even if seal appears intact Single-dose draws: If drawing entire vial in one session, seal integrity not an issue Can preload syringes for convenience (store in fridge, use within week) Extending shelf life: tips and tricks While 28-30 days is standard, these practices maximize longevity