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Initial investigations into the causes of adult onset GHD showed them to result from damage to the pituitary gland due to tumors, surgery or radiotherapy that disrupted function of the GH neuroendocrine axis

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Concurrently, liver insulin resistance promotes de novo lipogenesis ( de novo lipogenesis through sterol regulatory element-binding protein 1c (SREBP-1c) activation, increasing the synthesis of triglycerides and very-low-density lipoproteins (VLDL), contributing to MASLD and systemic dyslipidemia Figure 4 (50, 52, 53)

It has even recently been suggested that cortical electroencephalogram arousal patterns are not sufficiently sensitive to detect arousals from sleep in children, and that outputs of the autonomic nervous system may be a better alternative for this purpose (29)