IGF1 and multiple endocrine neoplasia type 4: Ninety-five percent of the cases are sporadic, and 50% of the cases are present in childhood as a part of familial diseases such as familial isolated pituitary adenoma (FIPA), X linked acrogigantism (XLAG), multiple endocrinal neoplasia-1 and 4 (MEN-1 and MEN-4), Carney complex, McCune-Albright syndrome, neurofibromatosis or ‘3PAs’ syndrome [5]. When GH enters blood circulation, it signals the liver to produce another hormone, called insulin-like growth factor-1 (IGF-1) which mediates many GH effects [6].