mkdir -p /home/daytona/workspace/growth-hormone-ppt && ls /home/daytona/workspac…

~/growth-hormone-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Presentation";
pres.title = "Growth Hormone and Its Applications";

// === THEME COLORS ===
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const LIGHT_BG  = "F0F4F8";   // near-white slides
const TEXT_DARK = "1A1A2E";   // body text on light bg
const TEXT_LIGHT= "FFFFFF";   // body text on dark bg
const SUBTEXT   = "B0BEC5";   // muted text

// ============================================================
// HELPER FUNCTIONS
// ============================================================

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// ============================================================
// SLIDE 1: TITLE
// ============================================================
addTitleSlide(pres,
  "Growth Hormone\nand Its Applications",
  "Physiology · Pathophysiology · Clinical Use"
);

// ============================================================
// SLIDE 2: OUTLINE
// ============================================================
{
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    color: TEXT_LIGHT, fontFace: "Calibri", charSpacing: 4, margin: 0
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  const sections = [
    "01  Introduction & Overview",
    "02  Chemistry & Structure",
    "03  Regulation of Secretion",
    "04  Physiological Actions",
    "05  IGF-1 & Downstream Signaling",
    "06  Disorders: GH Deficiency",
    "07  Disorders: GH Excess (Acromegaly / Gigantism)",
    "08  Clinical Applications & Therapy",
    "09  Pharmacological Agents",
    "10  Summary & Key Points"
  ];

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}

// ============================================================
// SECTION 1 DIVIDER
// ============================================================
addSectionDivider(pres, "Introduction & Overview", "01");

// ============================================================
// SLIDE 3: Introduction
// ============================================================
addContentSlide(pres, "What Is Growth Hormone (GH)?", [
  "GH (somatotropin) is a 191-amino acid polypeptide hormone secreted by somatotroph cells of the anterior pituitary gland",
  "It is the MOST abundant anterior pituitary hormone — somatotropes constitute up to 50% of the total anterior pituitary cell population",
  "Two major isoforms: 22-kDa (predominant) and 20-kDa from alternative splicing of the hGH-N gene — both have similar biologic activity",
  "Placental GH variant (hGH-V) expressed by syncytiotrophoblasts; related hormone human chorionic somatotropin (HCS) also encoded in the gene cluster",
  "GH is the principal endocrine regulator of somatic growth and also has major metabolic effects throughout life",
  "Secretion is pulsatile; highest peak levels occur at night, generally correlating with sleep onset"
]);

// ============================================================
// SECTION 2 DIVIDER
// ============================================================
addSectionDivider(pres, "Chemistry & Structure", "02");

// ============================================================
// SLIDE 4: Chemistry
// ============================================================
addContentSlide(pres, "Chemistry & Molecular Structure", [
  "Single-chain polypeptide — 191 amino acids, MW ~22 kDa; contains 2 disulfide bonds",
  "Synthesized as a larger 'pre-hormone'; processed through ER and Golgi system — signal peptide removed before secretion",
  "Five distinct genes encode GH and related proteins (gene cluster on chromosome 17)",
  "Pit-1 nuclear transcription factor is essential for somatotrope development and GH gene expression",
  "GH receptor: 70-kDa transmembrane protein with structural homology to the cytokine/hematopoietic superfamily",
  "Soluble GH Binding Protein (GHBP) is derived from cleavage of the extracellular domain of GH receptor — binds ~40–50% of circulating GH",
  "Signal transduction: GH binds to preformed receptor dimers → JAK2/STAT5 pathway activation → nuclear translocation → gene expression"
]);

// ============================================================
// SECTION 3 DIVIDER
// ============================================================
addSectionDivider(pres, "Regulation of Secretion", "03");

// ============================================================
// SLIDE 5: Regulation
// ============================================================
addTwoColSlide(pres,
  "Regulation of GH Secretion",
  "STIMULATORS",
  [
    "GHRH (Growth Hormone-Releasing Hormone): 44-aa hypothalamic peptide → acts via GPCR/cAMP to stimulate GH synthesis & release",
    "Ghrelin: octanoylated gastric peptide — binds GHS-R in hypothalamus & pituitary to stimulate GHRH and GH release directly",
    "Deep slow-wave sleep (largest daily GH pulse)",
    "Exercise, physical stress, trauma, sepsis",
    "Hypoglycemia (insulin-induced)",
    "Estrogen: enhances GH secretion; women have higher 24-h integrated GH output",
    "α-Adrenergic agonists, L-arginine, dopamine"
  ],
  "INHIBITORS",
  [
    "Somatostatin (SRIF): 14-aa cyclic peptide from hypothalamus medial preoptic area; sets basal GH tone; binds SST1–5 receptors",
    "IGF-1: major negative feedback — high IGF-1 suppresses GH via hypothalamic and pituitary receptors",
    "Hyperglycemia: glucose load suppresses GH to <0.07 μg/L (men) / <0.7 μg/L (women)",
    "Chronic glucocorticoid excess suppresses GH release → growth delay in children",
    "Obesity: reduced GH secretion (though IGF-1 may remain normal)",
    "β-Adrenergic agonists, free fatty acids",
    "GH itself (short-loop feedback)"
  ]
);

// ============================================================
// SLIDE 6: Secretion Patterns
// ============================================================
addContentSlide(pres, "GH Secretion Patterns & Physiology", [
  "Pulsatile secretion: GHRH released in discrete spikes elicits GH pulses; SRIF sets baseline tone between pulses",
  "Diurnal pattern: peak GH pulse occurs 60–90 min after sleep onset (associated with slow-wave sleep); typically 5–7 pulses/day",
  "Age-related decline: GH secretory rates in middle age are ~15% of pubertal peak; parallels decline in lean muscle mass",
  "Sex differences: men have higher GH pulsatility; women have relatively more continuous basal GH secretion — affects hepatic enzyme induction and linear growth",
  "Random GH measurements are unreliable (undetectable in ~50% of normal individuals at any given time) — IGF-1 is the preferred screening marker",
  "Nutritional state profoundly affects GH: chronic malnutrition/fasting → increased pulse frequency and amplitude; obesity → reduced GH secretion"
]);

// ============================================================
// SECTION 4 DIVIDER
// ============================================================
addSectionDivider(pres, "Physiological Actions", "04");

// ============================================================
// SLIDE 7: GH Actions
// ============================================================
addContentSlide(pres, "Physiological Actions of Growth Hormone", [
  "Linear bone growth: stimulates epiphyseal prechondrocyte differentiation; widens growth plates; increases long bone length (pre-pubertal)",
  "Protein anabolism: induces protein synthesis and nitrogen retention → increased lean body mass",
  "Lipolysis: mobilizes free fatty acids from adipose tissue → reduces omental fat, raises circulating FFA, favors ketogenesis",
  "Anti-insulin / diabetogenic: decreases glucose uptake in some tissues, increases hepatic glucose output, impairs insulin sensitivity",
  "Fluid & mineral balance: promotes sodium, potassium, and water retention; elevates serum inorganic phosphate",
  "Organ growth: heart, liver, kidney, skin, muscle, GI tract all respond to chronic GH excess",
  "Immune function: GH receptors present on immune cells; GH promotes thymic function and lymphocyte activity"
]);

// ============================================================
// SECTION 5 DIVIDER
// ============================================================
addSectionDivider(pres, "IGF-1 & Downstream Signaling", "05");

// ============================================================
// SLIDE 8: IGF-1
// ============================================================
addContentSlide(pres, "IGF-1: The GH Mediator", [
  "Insulin-Like Growth Factor-1 (IGF-1, somatomedin C): 70-aa single-chain polypeptide; major mediator of GH's growth-promoting actions",
  "Liver is the primary source of circulating IGF-1; local IGF-1 also produced in peripheral tissues (paracrine/autocrine effects)",
  "IGF-1 levels: rise during puberty, peak at age 16, then decline >80% during aging; higher in women than men",
  "6 high-affinity IGF Binding Proteins (IGFBPs): IGFBP3 (major carrier, GH-dependent) prolongs IGF-1 half-life from minutes to hours",
  "JAK2/STAT5 pathway: GH → JAK2 phosphorylation → STAT5 dimerization → nuclear translocation → IGF-1 gene transcription",
  "IGF-1 actions: promotes chondrocyte proliferation, protein synthesis, glucose uptake (insulin-like); feedback-inhibits GH secretion",
  "Clinical use: serum IGF-1 is the best single test for GH excess/deficiency — reflects integrated 24-h GH secretion"
]);

// ============================================================
// SECTION 6 DIVIDER
// ============================================================
addSectionDivider(pres, "GH Deficiency", "06");

// ============================================================
// SLIDE 9: GH Deficiency
// ============================================================
addTwoColSlide(pres,
  "Growth Hormone Deficiency (GHD)",
  "IN CHILDREN",
  [
    "Normal birth weight and length — growth failure begins after 6 months",
    "Dwarfism / short stature (fall below growth curve for peers)",
    "Mild obesity, 'younger-appearing' body habitus",
    "Delayed puberty; possibly small genitalia (hypogonadism)",
    "Neonatal hypoglycemia (loss of counter-regulatory effect)",
    "Causes: hypothalamic GHRH deficiency, primary pituitary failure, GH receptor defects (Laron dwarfism), IGF-1 generation failure",
    "Laron dwarfism: elevated GH + absent IGF-1 → GH receptor mutation; does NOT respond to exogenous GH"
  ],
  "IN ADULTS",
  [
    "No major clinical illness (unlike childhood GHD)",
    "Increased body fat (especially central/omental), reduced lean body mass",
    "Reduced bone mineral density → osteoporosis risk",
    "Impaired cardiac structure & function, reduced exercise capacity",
    "Fatigue, reduced quality of life, possible psychological effects",
    "Metabolic syndrome features: dyslipidemia, insulin resistance",
    "Diagnosis confirmed if 3 pituitary hormones deficient + low IGF-1; otherwise requires provocative testing"
  ]
);

// ============================================================
// SLIDE 10: Diagnosis of GHD
// ============================================================
addContentSlide(pres, "Diagnosis of Growth Hormone Deficiency", [
  "Serum IGF-1: best single screening test — low levels suggest GHD; reflects integrated GH secretion",
  "IGFBP-3: GH-dependent binding protein; low in GHD; useful alongside IGF-1 for pediatric diagnosis",
  "Provocative (stimulation) tests: required in most cases because random GH is unreliable; agents used include insulin (ITT), arginine, GHRH+arginine, glucagon",
  "Insulin Tolerance Test (ITT): gold standard — hypoglycemia provokes GH release; peak GH <5 ng/mL = severe GHD",
  "MRI pituitary: evaluate for structural lesion, tumor, or hypoplasia",
  "Children diagnosed with idiopathic GHD should be re-tested as adults (some GHD resolves)",
  "If 3 pituitary hormones are deficient AND IGF-1 is below normal range → provocative testing is NOT required"
]);

// ============================================================
// SECTION 7 DIVIDER
// ============================================================
addSectionDivider(pres, "GH Excess: Acromegaly & Gigantism", "07");

// ============================================================
// SLIDE 11: Acromegaly / Gigantism
// ============================================================
addTwoColSlide(pres,
  "GH Excess: Gigantism vs. Acromegaly",
  "GIGANTISM (Pre-pubertal excess)",
  [
    "GH excess BEFORE epiphyseal plate closure",
    "Intense stimulation at growth plates → dramatic increase in linear height",
    "Can reach heights >2.7 m (e.g., the 'Alton Giant')",
    "Most often due to GH-secreting pituitary adenoma present from early childhood",
    "Features: exaggerated height, coarse features beginning early, headache",
    "Treatment: transsphenoidal surgery + somatostatin analogues"
  ],
  "ACROMEGALY (Post-pubertal excess)",
  [
    "GH excess AFTER epiphyseal plates close at puberty",
    "No increase in height — instead periosteal bone thickening",
    "Coarsening of facial features, prognathism, enlarged hands/feet/tongue",
    "Organomegaly: heart, liver, kidney, GI tract",
    "Metabolic: insulin resistance, glucose intolerance — 25% develop overt diabetes",
    "Cardiovascular complications: hypertension, cardiomegaly → #1 cause of mortality",
    "Sleep apnea, arthropathy, carpal tunnel syndrome if untreated"
  ]
);

// ============================================================
// SLIDE 12: Diagnosis & Treatment of Acromegaly
// ============================================================
addContentSlide(pres, "Acromegaly: Diagnosis & Management", [
  "Diagnosis: serum IGF-1 elevation is the best screening test; log-linear relationship with GH levels in acromegaly",
  "Confirmatory: 75 g oral glucose tolerance test (OGTT) — failure to suppress GH to <1 ng/mL is diagnostic",
  "Imaging: MRI pituitary — most have macroadenoma; assess cavernous sinus invasion",
  "Treatment of choice: Transsphenoidal resection of the pituitary adenoma (first-line, potentially curative)",
  "If IGF-1 remains elevated post-surgery: Somatostatin analogues (octreotide LAR, lanreotide) — suppress GH/IGF-1 in majority",
  "Pegvisomant: GH receptor antagonist — blocks GH action at receptor level; approved for acromegaly; normalizes IGF-1 in >90% of patients",
  "Radiotherapy: used when surgery + medical therapy fail to control; takes years for full effect; risk of hypopituitarism",
  "Cabergoline (dopamine agonist): adjunct therapy, especially for GH/PRL co-secreting tumors"
]);

// ============================================================
// SECTION 8 DIVIDER
// ============================================================
addSectionDivider(pres, "Clinical Applications & Therapy", "08");

// ============================================================
// SLIDE 13: Therapeutic Uses
// ============================================================
addContentSlide(pres, "Approved Clinical Applications of Recombinant GH (rhGH)", [
  "Childhood GH Deficiency: first and primary indication — recombinant hGH (somatropin) restores normal growth velocity; avg 9–10 cm gain in year 1",
  "Adult GH Deficiency: low-dose rhGH (2–5 μg/day SC); improves body composition, bone density, exercise capacity, and quality of life",
  "Turner Syndrome: rhGH increases final adult height by ~8–10 cm when started early",
  "Prader-Willi Syndrome: rhGH approved — improves muscle tone, body composition, growth, and cognitive function",
  "Chronic Kidney Disease (pediatric): rhGH improves growth in pre-dialysis and dialysis patients",
  "Small for Gestational Age (SGA): children who fail catch-up growth by age 2–4 years are eligible for rhGH therapy",
  "AIDS Wasting / Cachexia: rhGH reduces visceral fat, increases lean mass in HIV-associated lipodystrophy",
  "Short Bowel Syndrome: rhGH (Zorbtive) — FDA-approved adjunct to specialized nutritional support"
]);

// ============================================================
// SLIDE 14: Long-Acting GH & Newer Agents
// ============================================================
addContentSlide(pres, "GH Therapy: Dosing, Formulations & Monitoring", [
  "Daily somatropin (SC injection): standard; dose in children: 20–35 μg/kg/day; dose titrated to maintain IGF-1 in mid-normal range for age",
  "Long-acting formulation — Lonapegsomatropin (TransCon hGH): 0.24 mg/kg/week SC; once-weekly; FDA-approved; recommended over daily somatropin in pediatric GHD",
  "Somapacitan (Sogroya): another once-weekly rhGH; approved for adults and children",
  "Evening dosing preferred — mimics physiologic nocturnal GH surge",
  "Monitoring: serum IGF-1 and IGFBP-3 every 3–6 months; keep IGF-1 within normal range; growth velocity charts in children",
  "Side effects: fluid retention (edema, carpal tunnel), benign intracranial hypertension, glucose intolerance, slipped capital femoral epiphysis",
  "Contraindications: active malignancy, proliferative retinopathy, intracranial hypertension, active Prader-Willi patients who are severely obese / have sleep apnea"
]);

// ============================================================
// SECTION 9 DIVIDER
// ============================================================
addSectionDivider(pres, "Pharmacological Agents", "09");

// ============================================================
// SLIDE 15: Pharmacology Summary
// ============================================================
addHighlightSlide(pres, "Key Pharmacological Agents in the GH Axis", [
  {
    label: "SOMATOSTATIN ANALOGUES",
    value: "• Octreotide (LAR) — long-acting\n• Lanreotide (Autogel)\n• Pasireotide (multi-receptor)\n\nMechanism: mimic endogenous somatostatin; bind SST2/SST5 on somatotropes → inhibit GH release\n\nUse: acromegaly (post-op residual), GH-secreting tumors, carcinoid syndrome",
    color: "162B44"
  },
  {
    label: "GH RECEPTOR ANTAGONIST",
    value: "• Pegvisomant\n\nMechanism: mutated GH analogue that binds GH receptor but CANNOT induce receptor dimerization → blocks GH signaling\n\nUse: acromegaly refractory to surgery + SRLs; normalizes IGF-1 in >90%\n\nMonitoring: liver enzymes; IGF-1 NOT GH",
    color: "162B44"
  },
  {
    label: "RECOMBINANT GH",
    value: "• Somatropin (daily)\n• Lonapegsomatropin (weekly)\n• Somapacitan (weekly)\n\nMechanism: identical to endogenous GH; binds GH receptor → JAK/STAT signaling\n\nUse: GHD children & adults, Turner, Prader-Willi, SGA, SBS, CKD",
    color: "162B44"
  },
  {
    label: "GHRH / GHRELIN AGONISTS",
    value: "• Tesamorelin (GHRH analogue): FDA-approved for HIV-associated lipodystrophy — reduces visceral fat\n\n• Macimorelin (oral GHS-R agonist): used as a GHD diagnostic test (replaces ITT in some centres)\n\n• Ibutamoren (MK-677): investigational oral ghrelin mimetic",
    color: "162B44"
  }
]);

// ============================================================
// SLIDE 16: GH & Metabolic Interactions
// ============================================================
addContentSlide(pres, "GH, Metabolism & Special Considerations", [
  "Diabetogenic effect: GH antagonizes insulin action → worsens glucose tolerance; 25% of acromegaly patients develop diabetes mellitus",
  "Starvation/fasting: GH rises markedly — mobilizes FFA for fuel while preserving glucose for brain; ketosis may be partly GH-mediated",
  "Cardiac effects: GH deficiency → cardiac dysfunction; GH replacement delays progression of heart failure in GHD patients",
  "Bone: GH/IGF-1 axis promotes bone formation; GHD adults have reduced BMD; replacement therapy improves bone density over 1–2 years",
  "Aging (somatopause): progressive decline in GH/IGF-1 with aging — associated with sarcopenia, increased adiposity, reduced bone density",
  "GH and cancer: IGF-1 is a mitogen — concern for tumor promotion; GH therapy is contraindicated in patients with active malignancy",
  "Doping / misuse: rhGH is abused by athletes for anabolic/lipolytic effects; banned by WADA; detected by GH biomarker tests"
]);

// ============================================================
// SECTION 10: SUMMARY
// ============================================================
addSectionDivider(pres, "Summary & Key Points", "10");

// ============================================================
// SLIDE 17: Key Points
// ============================================================
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK_BG } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: MID_BG } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.05, fill: { color: ACCENT } });

  slide.addText("KEY TAKEAWAYS", {
    x: 0.35, y: 0.1, w: 9.3, h: 0.7, fontSize: 24, bold: true,
    color: TEXT_LIGHT, fontFace: "Calibri", charSpacing: 3, valign: "middle", margin: 0
  });

  const points = [
    { num: "01", text: "GH is the most abundant anterior pituitary hormone — controlled by GHRH (stimulates) and somatostatin (inhibits), with pulsatile nocturnal secretion" },
    { num: "02", text: "Many GH actions are mediated through IGF-1 (made in liver) — serum IGF-1 is the preferred diagnostic marker for both excess and deficiency" },
    { num: "03", text: "GH deficiency in childhood → dwarfism; in adults → metabolic syndrome, cardiac dysfunction, poor quality of life" },
    { num: "04", text: "GH excess pre-puberty → gigantism; post-puberty → acromegaly (acral enlargement, organomegaly, hypertension, diabetes)" },
    { num: "05", text: "Recombinant GH therapy (somatropin, lonapegsomatropin) is approved for GHD, Turner, Prader-Willi, SGA, AIDS wasting, and short bowel syndrome" },
    { num: "06", text: "Acromegaly treatment: surgery first, then somatostatin analogues or pegvisomant (GH receptor antagonist) for residual disease" }
  ];

  points.forEach((p, i) => {
    const y = 1.0 + i * 0.74;
    slide.addShape(pres.ShapeType.rect, { x: 0.3, y: y, w: 0.5, h: 0.55, fill: { color: ACCENT }, rectRadius: 0.08 });
    slide.addText(p.num, { x: 0.3, y: y + 0.05, w: 0.5, h: 0.45, fontSize: 14, bold: true, color: DARK_BG, fontFace: "Calibri", align: "center", margin: 0 });
    slide.addText(p.text, {
      x: 0.95, y: y + 0.04, w: 8.7, h: 0.55,
      fontSize: 13.5, color: i % 2 === 0 ? TEXT_LIGHT : SUBTEXT,
      fontFace: "Calibri", valign: "middle", margin: 0
    });
  });
}

// ============================================================
// SLIDE 18: END / THANK YOU
// ============================================================
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK_BG } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 2.5, w: "100%", h: 0.08, fill: { color: ACCENT } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 2.58, w: "100%", h: 0.08, fill: { color: ACCENT2 } });

  slide.addText("Thank You", {
    x: 0.5, y: 0.6, w: 9, h: 1.5, fontSize: 52, bold: true,
    color: TEXT_LIGHT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0
  });
  slide.addText("Growth Hormone and Its Applications", {
    x: 0.5, y: 2.8, w: 9, h: 0.65, fontSize: 20,
    color: ACCENT, fontFace: "Calibri", align: "center", margin: 0
  });
  slide.addText("Sources: Harrison's Principles of Internal Medicine 22E · Goldman-Cecil Medicine · Costanzo Physiology · Medical Physiology (Boron & Boulpaep) · Tietz Laboratory Medicine", {
    x: 0.5, y: 3.7, w: 9, h: 0.8, fontSize: 11,
    color: SUBTEXT, fontFace: "Calibri", align: "center", wrap: true, margin: 0
  });
}

// ============================================================
// SAVE
// ============================================================
pres.writeFile({ fileName: "/home/daytona/workspace/growth-hormone-ppt/Growth_Hormone_and_Applications.pptx" })
  .then(() => console.log("SUCCESS: Growth_Hormone_and_Applications.pptx created"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/growth-hormone-ppt && node create_ppt.js

ls -lh /home/daytona/workspace/growth-hormone-ppt/