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Hence, changes in intra-portal insulin levels need to be taken into consideration to correctly interpret the alterations in the GH/IGF-I axis in healthy and disease states as this helps the clinician in formulating the decision-making process of when and how to perform appropriate diagnostic work-up and whether to offer treatment to improve any accompanying metabolic consequences

A 2015 review in the Journal of Clinical Endocrinology confirming that GHRH analogs combined with ghrelin-pathway agonists produce a synergistic GH secretory response that exceeds additive effects when either compound is used alone provides the mechanistic basis for why combination therapy is the standard in supervised clinical settings