The follow-up protocol comprises (1) annual biochemical screening (PTH, calcium, TSH, free T4, metanephrines, cortisol, ACTH, IGF-1, and prolactin); (2) targeted imaging (thyroid ultrasound, echocardiography, and adrenal and pituitary MRI); (3) patient education (symptom tracking for catecholamine excess, hypocalcemia, or embolic signs); and (4) family member counseling if new findings emerge or the patient consents to future genetic testing [1,11]. The gene discussed is IGF1; the disease is Hypocalcemia.