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Some define elevation as a value at or above 1,000 ng/L, which is the same as 1,000 pg/mL and roughly 738 pmol/L, while others set the bar at more than 1,000 pmol/L, closer to 1,355 pg/mL

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

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