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PMID: 26164674

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For example, a meta-analysis of 31 randomized, controlled trials reports that the most common side effects observed in the hGH studies and their respective incidences were [16]: Soft tissue edema: 50% Insulin resistance: 22% Arthralgias: 21% Carpal tunnel syndrome: 19% These side effects are transient and usually subside as the patient gets used to the therapy

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If a protocol adds frequency or increases dose without a clear reason, the study may stop testing a clean pulse-based design and start testing accumulation of procedural stress