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Gynecol Oncol (2014) 133(3):62431

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IGF-1 deficiency impairs endothelial NO bioavailability through elevation of NO breakdown due to increased generation of reactive oxygen species (ROS) and downregulation of endothelial nitric oxide synthase (eNOS) [168, 169]

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Patients may also experience side effects such as nausea, constipation, or fatigue, especially during the first few weeks of treatment

Various complex cellular and molecular mechanisms are associated with the disease pathogenesis