• Lowering of the serum IGF-I  level – Nutrient deprivation,   malnutrition – Anorexia nervosa – Liver disease – Hypothyroidism – Poorly controlled insulin-  dependent diabetes   mellitus – Oral estrogen use• Inaccurate IGF-I normal  range (upper limit too high). This evidence concerns the gene IGF1 and type 1 diabetes mellitus.