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Physical signs suggestive of liver disease : Hepatomegaly (enlarged liver), spider naevi, palmar erythema, or unexplained abdominal discomfort should prompt investigation

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Metabolic rate (influenced by thyroid function, body composition, and physical activity) also modulates drug clearance, with higher metabolic rates potentially shortening half life and lower rates extending it

Additionally, systemic side effects associated with sustained growth hormone stimulation include symptoms such as abnormal tissue growth, joint discomfort, and potential enlargement of the heart (cardiomegaly), Roberts says (21)

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