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B12 circulates and binds to transport proteins that carry it to cells throughout your body, where it participates in energy metabolism, DNA synthesis, and myelin production

In some cases, doctors may recommend hydroxocobalamin injections for the rest of the person's life

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Physical examination may reveal pallor, glossitis, neurological signs such as reduced vibration sense or proprioception, and in advanced cases, ataxia or cognitive impairment

They bind to specific receptors in the hypothalamus and pituitary gland, triggering pulsatile GH release