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70% of tracheal lumen), recurrent nerve, esophagus (expecially from retrosternal goitre), or sympathetic trunk (miosis, enophathalmos).

This is initially due to a transient GH resistance, but in the longer term, the less pulsatile pattern of GH secretion may be a major factor since only pulsatile growth hormone increases the levels of IGF-I and the acid-labile subunit.

There is evidence that changes in the GH/IGF-I axis are permissive to protein catabolism.

The GH-activated pathways that mediate the increase in IGF-I levels are not well understood, thereby impeding the elucidation of the effect of inflammatory cytokines.

Several signalling cascades, like the JAK-STAT and MAP kinase pathways, have been shown to be activated by GH and some inflammatory cytokines, hence raising the possibility of crosstalk on this level.

Moreover, many of these conditions are also associated with an inability of GH to stimulate hepatic IGF-I synthesis.

This defect results from an impaired phosphorylation and activation of the traditional JAK2/STAT5 signal transduction pathway.

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