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Two clinically important transaminases are AST/GOT (interconverting aspartate/oxaloacetate and glutamate/α-ketoglutarate) and ALT/GPT (interconverting alanine/pyruvate and glutamate/α-ketoglutarate)

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The most common cause is insufficient pituitary somatotroph reserve, often from aging beyond the point where secretagogue therapy can restore adequate GH output