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However, as a molecule with close structural homology to insulin, IGF-1 elicits a variety of metabolic products in vitro and in vivo that are similar to insulin, which can cause edema primarily in the face and hands, mild weight gain, occasional dyspnea, bilateral jaw tenderness, arthralgias and myalgias, fatigue, tachycardia, flushing, orthostatic, and hypotension [57]