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Because it binds to the ghrelin receptor the same receptor responsible for hunger signaling, metabolic regulation, and cardiovascular modulation its side effect profile is shaped not only by elevated GH and downstream IGF-1 activity, but also by direct ghrelin receptor agonism across multiple biological systems

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However, 2025 treatment guidelines have shifted away from these due to augmentationa phenomenon where symptoms worsen over time, requiring dose escalation in a cycle of dependency

Ghosh A, et al