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People with pernicious anaemia need large doses of vitamin B12 given at regular intervals, usually as an intramuscular injection (Obeid et al., 2015

It is also possible that hypothalamic/pituitary autoimmunity may be present in ME/CFS- particularly in the more severe cases- as antipituitary and antihypothalamic antibodies have been identified (430)

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Disruptions in the IGF-I signalling pathway also result in reduced intrauterine growth as observed in mice deficient in Akt1 (Cho et al ., 2001), insulin receptor substrate-1 (IRS-1) and IRS-2 (Araki et al ., 1994