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While we can learn from treatment anecdotes, the case reports, series, and small, uncontrolled studies conducted and reported to date must be interpreted with great caution, as their design makes it impossible to discern whether an intervention was responsible for the clinical changes observed in patients or participants

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This paradox may be explained by the increased insulin resistance and the compensatory intra-portal hyperinsulinemia causing increased hepatic GH sensitivity that increases serum IGF-I and blunts pituitary GH secretion via the negative feedback loop