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Common symptoms include: Persistent fatigue and weakness Pale or jaundiced skin Heart palpitations and shortness of breath Nerve problems such as numbness or tingling Cognitive disturbances such as memory loss Glossitis and mouth ulcers High homocysteine levels, leading to cardiovascular issues Given the severe symptoms associated with Vitamin B12 deficiency, timely and effective treatment becomes essential

Acromegaly is usually caused by anterior pituitary gland tumours which secrete growth hormone

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Acknowledgements We thank the staff at the X-ray core facility of Korea Basic Science Institute (Ochang, Korea) and BL-5C of the Pohang Accelerator Laboratory (Pohang, Korea) for their assistance with data collection

Temporal Dynamics and Optimal Administration Strategies The temporal relationship between GHRH and GHRP administration significantly influences the magnitude of synergistic effect