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While IGF-I remains the biomarker that best reflects endogenous GH secretion, when there is a discordancy with GH and IGF-I levels, it is important for the clinician to be mindful of the associated changes in intra-portal insulin delivery to the liver when interpreting these results in the context of health and when deciding treatment regimens in disease states

Further Manifestations If the clinical manifestations mentioned above are left unaddressed, they may evolve into further issues (as noted as dark blue boxes in the above graphic)