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Figure 1 Neuropathic signs detected on basic neurological examination including bedside sensory tests and foot inspection include (a) sensory deficit in large nerve fiber (via 128 Hz tuning fork for vibration sensation, 1 and 10 g monofilament for pressure sensation and wisp of cotton for light touch sensation), (b) sensory deficit in small nerve fiber (via neurotips for pain-pinprick sensation) and cold tuning fork for cold sensation), (c) allodynia (pain triggered by normally non-painful stimuli such as the contact of socks, shoes, or bedclothes), (d) hyperalgesia (exaggerated response to painful stimuli), (e) motor weakness (extension of the big toe, ankle dorsiflexion, and walking on heels), (f) absence of reflexes (ankle and patellar deep tendon reflexes), (g) balance and fall risk (Romberg test, normal gait, and tandem gait), and (h) inspection of feet (for deformities, ulcers, fungal infection, muscle wasting, hair distribution or loss, and the presence or absence of pulses) ( Table 2

doi: 10.1158/0008-5472.CAN-07-5659 152 PerroneFLampisAOrsenigoMDi BartolomeoMGevorgyanALosaMet al

HGH tends to produce favourable body composition changessimultaneous fat loss and lean mass gain