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The other adverse effect of the use of rhIGF-1 observed in GH receptor-deficient patients is hypoglycemia, due to low levels of IGFBP3 and increased level of free IGF-1 available for binding to insulin receptors [32]

The more common cause of TP reduction is the decrease in ALB, which is the major protein component of serum TP, playing a role in maintaining plasma osmotic pressure and transporting nutrients (37)

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Preclinical studies have shown that cobalamin inhibits glutamate exocytosis, as an excitatory pain neurotransmitter, and when infused intracerebroventricularly, increases GABA cell contents, as an inhibitory pain neurotransmitter [6, 9]