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Other documented findings include a tendency toward IGF-1 receptor desensitization with prolonged, continuous exposure, transient fluid retention in early study phases, and at supraphysiological exposure levels examined in some research acromegaly-like tissue changes

Siudak, Z

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E.WoodW.AusubelF

2025 Mar;31(3):1038

For patients whose levels fall in the borderline or gray zone, a methylmalonic acid (MMA) test provides greater specificity MMA levels rise when B12 is functionally inadequate at the cellular level, even if serum B12 appears borderline normal