{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T21:37:11Z","timestamp":1784929031217,"version":"3.55.0"},"reference-count":23,"publisher":"Bioscientifica","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity encompasses a heterogeneous group of conditions that include not only simple obesity, but also genetic and endocrine disorders. The growth hormone (GH)\u2013insulin-like growth factor 1 (IGF-1) axis plays a central role in body composition, insulin sensitivity, and metabolic regulation. We encountered three patients in whom the clinical courses highlighted distinct interactions between obesity and the GH\u2013IGF-1 axis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed three representative cases. Case 1 involved acromegaly improved by the peroxisome proliferator-activated receptor-\u03b1 (PPAR-\u03b1) agonist pemafibrate. Case 2 involved Prader\u2013Willi syndrome (PWS) with severe obesity treated using dulaglutide. Case 3 involved severe obesity managed with behavioral therapy. Clinical characteristics and therapeutic responses were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In case 1, pemafibrate administration resulted in a marked and sustained reduction in IGF-1 levels despite ongoing lanreotide therapy, suggesting a potential hepatic or pituitary interaction between PPAR-\u03b1 signaling and GH\u2013IGF-1 regulation. In case 2, dulaglutide induced weight loss and reduced insulin requirements in a patient with PWS, a condition characterized by high levels of ghrelin. The therapeutic effect may involve modulation of ghrelin, an upstream regulator of GH secretion. In case 3, a patient with a body mass index of 50.7 kg\/m2, behavioral therapy stabilized metabolic deterioration, even though GH and IGF-1 levels remained low after weight reduction, suggesting mechanisms independent of the GH\u2013IGF-1 axis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings support a conceptual shift from a linear GH\u2013IGF-1 axis to an integrated GH\u2013IGF-1 network that connects peripheral signals, hypothalamic regulation, and higher brain functions, offering a novel framework for personalized obesity management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-26-0317","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:44:00Z","timestamp":1781873040000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":1,"title":["PERSPECTIVE: Beyond the GH\u2013IGF-1 axis: a network perspective integrating clinical observations and mechanistic insights"],"prefix":"10.1530","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0293-5881","authenticated-orcid":true,"given":"Go","family":"Yoshimichi","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Shinbeppu Hospital 1 , , ,","place":["Beppu, Oita, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"2026071511221630600_bib1","first-page":"557","article-title":"Input-output organization in the hypothalamus relating to food intake behavior. 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