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In these patients, order a direct free copper assay if available

It may also be a sign of non-cancerous tumors, polyps, or ulcers

The confusion comes from somewhere specific

Other IGFBPs, including 2 and four to six, are also present in the fetus and umbilical circulation ( In mammals, including humans, rodents, and sheep, the mature IGF-1 protein contains 70 amino acids, but there is some variation in the amino acid sequence (Rotwein, 2017)

Loss-of-function variants in the CPT II gene are known to be pathogenic ( Management Suspect IEM in infants born to consanguineous couple with bad obstetric history or fetal brain/cardiac and/or renal anomalies

Xie et al., 2024)