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Additional information We declare that the manuscript has not been previously published, nor is it under consideration for publication elsewhere

Because GH and IGF-1 signaling can influence fluid balance, connective tissue, metabolism, and glucose regulation, potential GH-axis-related effects include: Water retention Peripheral edema Joint stiffness or discomfort Muscle aches Paresthesias or tingling Carpal-tunnel-like symptoms Changes in insulin sensitivity or glucose handling Adult GH replacement literature consistently identifies fluid-retention-related effects including edema, arthralgia, carpal tunnel syndrome, and paresthesias as common side effects of GH treatment