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[20] [21] Seek urgent medical advice if you are already taking a GLP-1 medication and experience: Severe, persistent abdominal pain (possible pancreatitis) A new lump in your neck or changes in your voice Symptoms of severe hypoglycaemia (if taking other diabetes medications) Signs of thyroid dysfunction despite stable levothyroxine therapy Persistent vomiting leading to dehydration or inability to take oral medications Severe right upper abdominal pain, fever or jaundice (possible gallbladder disease) Open communication with your healthcare team ensures that treatment decisions are individualised, evidence-based, and aligned with your health priorities

FIGURE 2 FIGURE 3 6 Critical appraisal and unresolved questions Although the preceding sections summarize the experimental and clinical literature linking the IGF axis to PAH, several unresolved contradictions remain in this field

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