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However, IGF-1 was shown to be an important growth-related hormone that has a GH-independent growth stimulating effects that in some cases acts synergistically with GH (172)

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89 In addition to ONOO -mediated oxidation of BH 4 , there may be also an intracellular decrease because of decreased synthesis by inhibition of the GTP cyclohydrolase I ( de novo synthetic pathway) or by inhibition of the so-called salvage pathway involving enzymes such as the sepiapterin synthase, the sepiapterin reductase or the dihydrofolate reductase

This is the most common presentation in functional medicine practice