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Skin hyperpigmentation in B12 deficiency was most commonly observed on the hands and feet (dorsal aspect), with the knuckles being the most prominent site

Teardo E, Carraretto L, De Bortoli S, Costa A, Behera S, Wagner R, Lo Schiavo F, Formentin E, Szab I (2014) Alternative splicing-mediated targeting of the Arabidopsis glutamate receptor 3.5 to mitochondria affects organelle morphology

A 2023 review in Frontiers in Physiology noted that mitochondrial-derived peptides like MOTS-c represent a functionally separate class from growth-hormone-axis compounds such as Tesamorelin underscoring why comparison, rather than substitution, is the right framework for evaluating them