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In addition, a number of factors, such as neurotransmitters, other hormones, and metabolic intermediates (amino acids, glucose, and free fatty acids), mainly acting at on the hypothalamic or pituitary level, or both, but also on the pituitary, can modify, both acutely and chronically, the pattern of GH release

The rationale focuses on local gut effects rather than systemic distribution

Some researchers also suggest it may interact with neurons via the Mitogen-Activated Protein Kinase (MAPK) pathway, which regulates intercellular signaling [15]

The procedural note for 20610 does not count toward E/M documentation