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Conditions include alcoholic liver disease, viral hepatitis, cirrhosis, and primary or metastatic liver cancer Renal dysfunction : Impaired kidney function reduces B12 elimination, causing accumulation even with normal intake Haematological conditions : Myeloproliferative neoplasms, chronic myeloid leukaemia, polycythaemia vera, and hypereosinophilic syndrome increase transcobalamin production, elevating total serum B12 Laboratory interference : Macro-B12 (immunoglobulin-bound B12) and assay interference can cause spuriously elevated results without true excess In clinical practice, unexplained hypercobalaminaemia should prompt investigation for underlying disease, particularly in patients without obvious supplementation history

Certain muscle groups observed in murine models, including the rectus abdominis, psoas major , and paraspinal muscles, showed a more pronounced increase in muscle density and volume, as well as a reduction in intramuscular fat content, than those observed in controls

For patients who are genuinely needle-averse, we discuss alternative delivery methods when available