Arthralgias and muscle aches, likened to ΓÇÿgrowing painsΓÇÖ, are encountered by several patients after commencing GH therapy. Some patients develop symptoms of carpal tunnel syndrome, and ankle oedema and hypertension can also occur in the first weeks of therapy, but all disappear within a week or two after reduction in dose. Most, if not all, of these side effects can be avoided by initiating replacement therapy at a low dose and thereafter increasing the dose gradually.