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The lack of adequate cobalamin in the body hinders the regeneration of tetrahydrofolate, which eventually leads to megaloblastic anemia due to the functional folate deficiency.[9][10] On the other hand, the methylmalonyl-CoA mutase helps to metabolize odd chain fatty acids and branch chain amino acids.[5] Cobalamin is also thought to keep the bodys level of sulfhydryl (SH) groups in reduced form

This progression is characterized by shifts in cortisol output, from an initial overproduction to eventual cortisol resistance and blunted output

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