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This situation was first reported in a boy with a deletion of exon 4 of the IGF-I gene (90) resulting in severe fetal and post-natal growth arrest, poor brain development and extreme insulin resistance with compensatory hyperinsulinemia and acanthosis nigricans

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Modalities: Physical therapy modalities (ultrasound, electrical stimulation, laser therapy) may complement peptide effects though evidence for synergy lacking

Conflict of interest Authors RE and JB were employed by the company Great Ormond Street Hospital for Children NHS Foundation Trust

As loading intensifies, the posterior lateral region becomes increasingly vulnerable to stress recruitment, thereby elevating injury susceptibility and potentially facilitating the progression of IDD (45)

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