Elevated cortisol directly inhibits GH receptor signaling in target tissues and increases hepatic GH resistance, meaning even if you achieve a GH pulse, downstream IGF-1 production and metabolic signaling are impaired
For example, fluoroquinolone completely inhibit CYP 3A4, quinidine heteroblocks CYP 2D6, and cimetidine and ketoconazole can block multiple enzymes by irreversibly binding to heme iron
Molecular Medicine Reports, 24(2), 605
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