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Other mechanisms include increased insulin resistance induced by high-dose glucocorticoids that increases intra-portal insulin, decreases IGFBP-1 that increases free IGF-I, and direct glucocorticoid effects in increasing hepatic IGF-I synthesis and decreasing hepatic insulin clearance (105)
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In a healthy pulsatile system, GH rises sharply, IGF-1 responds, and somatostatin steps in to bring the system back to normal before the next natural pulse
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