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Given that these inhibitory effects have been demonstrated in cultured GH-producing cells, they appear to be paracrine and independent of any action on hypothalamic somatostatin release, although it would be interesting to analyze whether nesfatins play a role in hypothalamic control of the synthesis and secretion of pituitary GH exerted by SS-GHRH, or on the neurotransmitters involved in this hypothalamic regulation of GH

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Early biochemical changes occur, such as an increase in homocysteine and methylmalonic acid (MMA), which indicate impaired B12 function