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Kidney Dysfunction: While the kidneys do not directly excrete vitamin B12 efficiently, impaired renal function may lead to elevated serum B12 levels by reducing the clearance of B12-binding proteins or altering their metabolism, thereby contributing to B12 accumulation 8

This configuration supports receptor-level interaction within adipocytes while minimizing affinity for the growth hormone receptor, distinguishing it from full-length GH and preventing downstream IGF-1 pathway activation

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