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secondary deficiency of IGF-1 ( 1 ). Several studies have shown that congenital GHD is associated with an increased risk of metabolic syndromes, such as nonalcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and hyperlipidemia ( 4
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, central adiposity, and the presence of non-alcoholic fatty liver disease ( 94 , 95 ). Because of its convenience, reproducibility, and high discriminatory power ( 96 , 97 ), this test was widely accepted in the United States until EMD Serono in 2008