Although the liver mainly produces IGF-1, every tissue can secrete IGF-1 for autocrine and paracrine purposes.3 IGF-1 possesses a large number of activities (anabolic, antioxidant, anti-inflammatory and cytoprotective actions), however, it is partly responsible for systemic GH actions.4 IGF-1 deficiency in TM patients in children and adolescents has been attributed to chronic anemia and hypoxia, chronic liver disease, iron overload and other associated endocrinopathies, e.g. growth hormone deficiency (GHD).5–11. This evidence concerns the gene IGF1 and hyperinsulinemic hypoglycemia, familial, 4.