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I've checked my notes this morning and the very same Gp is now saying I dont have PA just very low b12 (it was 109) Despite the fact it's there, logged clearly on the day of diagnosis

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Vitamin B12 and Folate Deficiency Anemia ICD-10 Codes (D51D53) These anemias behave differently

However, it is not known whether vitamin B 12 supplementation, in addition to folic acid supplementation, may be beneficial in the prevention of NTD (62) randomized controlled trials are needed to address this question

Elevated IGF-1 levels raise concerns about potential proliferative effects on existing malignancies, making growth hormone therapy problematic for individuals with cancer history or elevated cancer risk