• Dysregulation of GH  secretion – Disruption of the neural   or anatomic networks of   GH regulation – Mild or early GH excess?• Causes of abnormal GH  suppression other than  acromegaly – Chronic renal   insufficiency – Liver failure – Active hepatitis – Anorexia nervosa – Malnutrition – Hyperthyroidism – Diabetes mellitus – Adolescence• Cut-off for GH suppression  inappropriately low for the  GH assay used. Here, GH1 is linked to Hepatic failure.