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That is why serum IGF-1 is useful but incomplete it integrates GH exposure better than a random GH draw, but it says nothing about pulse amplitude, interpulse GH, tissue sensitivity, or free IGF-1

To derive the most consistent and safe evidence, in vitro studies, ex vivo perfusion methods, and in vivo animal and human studies can be applied together with the final aim to minimize potential fetotoxicity effects

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