home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-05 | 360.0 KB |
open in: 
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| 23 0f 00 00 30 31 00 00 | 00 01 bf 14 00 00 6b 11 |#...01..|......k.|
|00000030| 00 00 30 32 00 00 00 01 | 2a 26 00 00 e6 0f 00 00 |..02....|*&......|
|00000040| 30 33 00 00 00 01 10 36 | 00 00 36 0c 00 00 30 34 |03.....6|..6...04|
|00000050| 00 00 00 01 46 42 00 00 | 48 0b 00 00 30 35 00 00 |....FB..|H...05..|
|00000060| 00 01 8e 4d 00 00 66 0d | 00 00 30 36 00 00 00 01 |...M..f.|..06....|
|00000070| f4 5a 00 00 d5 0e 00 00 | 30 37 00 00 00 01 c9 69 |.Z......|07.....i|
|00000080| 00 00 34 0f 00 00 30 38 | 00 00 00 01 fd 78 00 00 |..4...08|.....x..|
|00000090| 38 0f 00 00 30 39 00 00 | 00 01 35 88 00 00 89 09 |8...09..|..5.....|
|000000a0| 00 00 31 30 00 00 00 01 | be 91 00 00 b8 0c 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 76 9e | 00 00 0f 12 00 00 31 32 |11....v.|......12|
|000000c0| 00 00 00 01 85 b0 00 00 | 4b 0c 00 00 31 33 00 00 |........|K...13..|
|000000d0| 00 01 d0 bc 00 00 82 0e | 00 00 31 34 00 00 00 01 |........|..14....|
|000000e0| 52 cb 00 00 07 0e 00 00 | 31 35 00 00 00 01 59 d9 |R.......|15....Y.|
|000000f0| 00 00 3e 0b 00 00 31 36 | 00 00 00 01 97 e4 00 00 |..>...16|........|
|00000100| 1c 0c 00 00 31 37 00 00 | 00 01 b3 f0 00 00 55 0d |....17..|......U.|
|00000110| 00 00 31 38 00 00 00 01 | 08 fe 00 00 bd 10 00 00 |..18....|........|
|00000120| 31 39 00 00 00 01 c5 0e | 01 00 c1 0a 00 00 32 30 |19......|......20|
|00000130| 00 00 00 01 86 19 01 00 | bc 0d 00 00 32 31 00 00 |........|....21..|
|00000140| 00 01 42 27 01 00 3e 0d | 00 00 32 32 00 00 00 01 |..B'..>.|..22....|
|00000150| 80 34 01 00 5e 0f 00 00 | 32 33 00 00 00 01 de 43 |.4..^...|23.....C|
|00000160| 01 00 fd 13 00 00 32 34 | 00 00 00 01 db 57 01 00 |......24|.....W..|
|00000170| 77 0f 00 00 32 35 00 00 | 00 01 52 67 01 00 4f 10 |w...25..|..Rg..O.|
|00000180| 00 00 32 36 00 00 00 01 | a1 77 01 00 00 14 00 00 |..26....|.w......|
|00000190| 32 37 00 00 00 01 a1 8b | 01 00 97 0d 00 00 32 38 |27......|......28|
|000001a0| 00 00 00 01 38 99 01 00 | 27 0c 00 00 32 39 00 00 |....8...|'...29..|
|000001b0| 00 01 5f a5 01 00 31 0c | 00 00 33 30 00 00 00 01 |.._...1.|..30....|
|000001c0| 90 b1 01 00 c7 0c 00 00 | 33 31 00 00 00 01 57 be |........|31....W.|
|000001d0| 01 00 8d 0e 00 00 33 32 | 00 00 00 01 e4 cc 01 00 |......32|........|
|000001e0| c2 0f 00 00 33 33 00 00 | 00 01 a6 dc 01 00 86 0b |....33..|........|
|000001f0| 00 00 33 34 00 00 00 01 | 2c e8 01 00 1a 0e 00 00 |..34....|,.......|
|00000200| 33 35 00 00 00 01 46 f6 | 01 00 2d 0e 00 00 33 36 |35....F.|..-...36|
|00000210| 00 00 00 01 73 04 02 00 | e5 0e 00 00 33 37 00 00 |....s...|....37..|
|00000220| 00 01 58 13 02 00 b2 0e | 00 00 33 38 00 00 00 01 |..X.....|..38....|
|00000230| 0a 22 02 00 03 0f 00 00 | 33 39 00 00 00 01 0d 31 |."......|39.....1|
|00000240| 02 00 2f 0b 00 00 34 30 | 00 00 00 01 3c 3c 02 00 |../...40|....<<..|
|00000250| 6c 0d 00 00 34 31 00 00 | 00 01 a8 49 02 00 fc 11 |l...41..|...I....|
|00000260| 00 00 34 32 00 00 00 01 | a4 5b 02 00 7c 0c 00 00 |..42....|.[..|...|
|00000270| 34 33 00 00 00 01 20 68 | 02 00 2f 0f 00 00 34 34 |43.... h|../...44|
|00000280| 00 00 00 01 4f 77 02 00 | 51 0e 00 00 34 35 00 00 |....Ow..|Q...45..|
|00000290| 00 01 a0 85 02 00 f5 0a | 00 00 34 36 00 00 00 01 |........|..46....|
|000002a0| 95 90 02 00 51 0d 00 00 | 34 37 00 00 00 01 e6 9d |....Q...|47......|
|000002b0| 02 00 a5 0e 00 00 34 38 | 00 00 00 01 8b ac 02 00 |......48|........|
|000002c0| 28 0c 00 00 34 39 00 00 | 00 01 b3 b8 02 00 df 0c |(...49..|........|
|000002d0| 00 00 35 30 00 00 00 01 | 92 c5 02 00 1c 11 00 00 |..50....|........|
|000002e0| 35 31 00 00 00 01 ae d6 | 02 00 d4 0e 00 00 35 32 |51......|......52|
|000002f0| 00 00 00 01 82 e5 02 00 | 2a 0c 00 00 35 33 00 00 |........|*...53..|
|00000300| 00 01 ac f1 02 00 76 0d | 00 00 35 34 00 00 00 01 |......v.|..54....|
|00000310| 22 ff 02 00 90 0c 00 00 | 35 35 00 00 00 01 b2 0b |".......|55......|
|00000320| 03 00 38 11 00 00 35 36 | 00 00 00 01 ea 1c 03 00 |..8...56|........|
|00000330| f8 10 00 00 35 37 00 00 | 00 01 e2 2d 03 00 01 0e |....57..|...-....|
|00000340| 00 00 35 38 00 00 00 01 | e3 3b 03 00 b6 0d 00 00 |..58....|.;......|
|00000350| 35 39 00 00 00 01 99 49 | 03 00 c6 0d 00 00 36 30 |59.....I|......60|
|00000360| 00 00 00 01 5f 57 03 00 | a4 0e 00 00 36 31 00 00 |...._W..|....61..|
|00000370| 00 01 03 66 03 00 6f 0e | 00 00 36 32 00 00 00 01 |...f..o.|..62....|
|00000380| 72 74 03 00 99 0d 00 00 | 36 33 00 00 00 01 0b 82 |rt......|63......|
|00000390| 03 00 34 0d 00 00 36 34 | 00 00 00 01 3f 8f 03 00 |..4...64|....?...|
|000003a0| 2d 14 00 00 36 35 00 00 | 00 01 6c a3 03 00 58 0b |-...65..|..l...X.|
|000003b0| 00 00 36 36 00 00 00 01 | c4 ae 03 00 f1 0e 00 00 |..66....|........|
|000003c0| 36 37 00 00 00 01 b5 bd | 03 00 10 0e 00 00 36 38 |67......|......68|
|000003d0| 00 00 00 01 c5 cb 03 00 | 48 11 00 00 36 39 00 00 |........|H...69..|
|000003e0| 00 01 0d dd 03 00 c4 0c | 00 00 37 30 00 00 00 01 |........|..70....|
|000003f0| d1 e9 03 00 5e 11 00 00 | 37 31 00 00 00 01 2f fb |....^...|71..../.|
|00000400| 03 00 b8 0d 00 00 37 32 | 00 00 00 01 e7 08 04 00 |......72|........|
|00000410| 76 10 00 00 37 33 00 00 | 00 01 5d 19 04 00 3c 0c |v...73..|..]...<.|
|00000420| 00 00 37 34 00 00 00 01 | 99 25 04 00 08 0e 00 00 |..74....|.%......|
|00000430| 37 35 00 00 00 01 a1 33 | 04 00 00 0f 00 00 37 36 |75.....3|......76|
|00000440| 00 00 00 01 a1 42 04 00 | b7 11 00 00 37 37 00 00 |.....B..|....77..|
|00000450| 00 01 58 54 04 00 78 0f | 00 00 37 38 00 00 00 01 |..XT..x.|..78....|
|00000460| d0 63 04 00 17 0e 00 00 | 37 39 00 00 00 01 e7 71 |.c......|79.....q|
|00000470| 04 00 ac 0d 00 00 38 30 | 00 00 00 01 93 7f 04 00 |......80|........|
|00000480| c3 12 00 00 38 31 00 00 | 00 01 56 92 04 00 11 0e |....81..|..V.....|
|00000490| 00 00 38 32 00 00 00 01 | 67 a0 04 00 52 09 00 00 |..82....|g...R...|
|000004a0| 38 33 00 00 00 01 b9 a9 | 04 00 d9 10 00 00 38 34 |83......|......84|
|000004b0| 00 00 00 01 92 ba 04 00 | ff 0f 00 00 38 35 00 00 |........|....85..|
|000004c0| 00 01 91 ca 04 00 77 0e | 00 00 38 36 00 00 00 01 |......w.|..86....|
|000004d0| 08 d9 04 00 78 0b 00 00 | 38 37 00 00 00 01 80 e4 |....x...|87......|
|000004e0| 04 00 ff 0c 00 00 38 38 | 00 00 00 01 7f f1 04 00 |......88|........|
|000004f0| f2 11 00 00 38 39 00 00 | 00 01 71 03 05 00 3f 11 |....89..|..q...?.|
|00000500| 00 00 39 30 00 00 00 01 | b0 14 05 00 22 0f 00 00 |..90....|...."...|
|00000510| 39 31 00 00 00 01 d2 23 | 05 00 d2 0a 00 00 39 32 |91.....#|......92|
|00000520| 00 00 00 01 a4 2e 05 00 | e3 0e 00 00 39 33 00 00 |........|....93..|
|00000530| 00 01 87 3d 05 00 56 11 | 00 00 39 34 00 00 00 01 |...=..V.|..94....|
|00000540| dd 4e 05 00 7e 0d 00 00 | 39 35 00 00 00 01 5b 5c |.N..~...|95....[\|
|00000550| 05 00 7a 10 00 00 39 36 | 00 00 00 01 d5 6c 05 00 |..z...96|.....l..|
|00000560| dd 0c 00 00 39 37 00 00 | 00 01 b2 79 05 00 68 0d |....97..|...y..h.|
|00000570| 00 00 39 38 00 00 00 01 | 1a 87 05 00 53 0d 00 00 |..98....|....S...|
|00000580| 39 39 00 00 00 01 6d 94 | 05 00 b4 0b 00 00 00 00 |99....m.|........|
|00000590| 00 00 00 00 21 a0 05 00 | 00 00 00 00 24 55 6e 69 |....!...|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 32 37 30 30 7d |que_ID{Y|RB02700}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 45 66 66 65 63 74 20 |..$Title|{Effect |
|000005c0| 6f 66 20 4c 6f 77 2d 44 | 6f 73 65 20 4f 72 61 6c |of Low-D|ose Oral|
|000005d0| 20 43 6f 6e 74 72 61 63 | 65 70 74 69 76 65 20 6f | Contrac|eptive o|
|000005e0| 6e 20 47 6f 6e 61 64 6f | 74 72 6f 70 69 6e 73 2c |n Gonado|tropins,|
|000005f0| 20 41 6e 64 72 6f 67 65 | 6e 73 2c 20 61 6e 64 0d | Androge|ns, and.|
|00000600| 0a 53 65 78 20 48 6f 72 | 6d 6f 6e 65 20 42 69 6e |.Sex Hor|mone Bin|
|00000610| 64 69 6e 67 20 47 6c 6f | 62 75 6c 69 6e 20 69 6e |ding Glo|bulin in|
|00000620| 20 4e 6f 6e 68 69 72 73 | 75 74 65 20 57 6f 6d 65 | Nonhirs|ute Wome|
|00000630| 6e 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 0d 0a 4d 75 |n}..$Aut|hor{..Mu|
|00000640| 72 70 68 79 2c 20 41 41 | 0d 0a 42 75 72 6b 6d 61 |rphy, AA|..Burkma|
|00000650| 6e 2c 20 52 54 0d 0a 43 | 72 6f 70 70 2c 20 43 53 |n, RT..C|ropp, CS|
|00000660| 0d 0a 5a 61 63 75 72 2c | 20 48 41 0d 0a 53 6d 69 |..Zacur,| HA..Smi|
|00000670| 74 68 2c 20 42 53 7d 0d | 0a 24 41 66 66 69 6c 69 |th, BS}.|.$Affili|
|00000680| 61 74 69 6f 6e 7b 55 6e | 69 76 20 6f 66 20 43 61 |ation{Un|iv of Ca|
|00000690| 6c 69 66 6f 72 6e 69 61 | 2c 20 53 61 6e 20 44 69 |lifornia|, San Di|
|000006a0| 65 67 6f 3b 20 4a 6f 68 | 6e 73 20 48 6f 70 6b 69 |ego; Joh|ns Hopki|
|000006b0| 6e 73 20 55 6e 69 76 7d | 0d 0a 24 4a 6f 75 72 6e |ns Univ}|..$Journ|
|000006c0| 61 6c 7b 46 65 72 74 69 | 6c 20 53 74 65 72 69 6c |al{Ferti|l Steril|
|000006d0| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 35 33 7d 0d 0a |}..$Volu|me{53}..|
|000006e0| 24 50 61 67 65 7b 33 35 | 2d 33 39 7d 0d 0a 24 44 |$Page{35|-39}..$D|
|000006f0| 61 74 65 7b 31 39 39 30 | 7d 0d 0a 24 59 42 56 6f |ate{1990|}..$YBVo|
|00000700| 6c 7b 31 39 39 31 20 59 | 65 61 72 20 42 6f 6f 6b |l{1991 Y|ear Book|
|00000710| 20 6f 66 20 4f 62 73 74 | 65 74 72 69 63 73 20 61 | of Obst|etrics a|
|00000720| 6e 64 20 47 79 6e 65 63 | 6f 6c 6f 67 79 7d 0d 0a |nd Gynec|ology}..|
|00000730| 24 43 68 61 70 74 65 72 | 7b 31 35 2d 31 30 7d 0d |$Chapter|{15-10}.|
|00000740| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00000750| 4d 69 73 68 65 6c 6c 2c | 20 4b 69 72 73 63 68 62 |Mishell,| Kirschb|
|00000760| 61 75 6d 2c 20 61 6e 64 | 20 4d 6f 72 72 6f 77 7d |aum, and| Morrow}|
|00000770| 0d 0a 24 54 61 62 6c 65 | 7b 54 61 62 6c 65 20 4f |..$Table|{Table O|
|00000780| 6d 69 74 74 65 64 7d 0d | 0a 24 43 6f 6d 6d 65 6e |mitted}.|.$Commen|
|00000790| 74 61 74 6f 72 7b 44 2e | 52 2e 20 4d 69 73 68 65 |tator{D.|R. Mishe|
|000007a0| 6c 6c 2c 20 4a 72 2e 2c | 20 4d 2e 44 2e 7d 0d 0a |ll, Jr.,| M.D.}..|
|000007b0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 43 29 20 |..Copyri|ght (C) |
|000007c0| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|000007d0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|000007e0| 63 2e 20 31 39 39 31 0d | 0a 0d 0a 31 39 39 31 20 |c. 1991.|...1991 |
|000007f0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4f 62 73 |Year Boo|k of Obs|
|00000800| 74 65 74 72 69 63 73 20 | 61 6e 64 20 47 79 6e 65 |tetrics |and Gyne|
|00000810| 63 6f 6c 6f 67 79 0d 0a | 0d 0a 47 79 6e 65 63 6f |cology..|..Gyneco|
|00000820| 6c 6f 67 79 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 |logy....|Chapter |
|00000830| 31 35 20 2d 2d 20 45 6e | 64 6f 63 72 69 6e 6f 6c |15 -- En|docrinol|
|00000840| 6f 67 79 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ogy....-|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000890| 2d 2d 2d 2d 2d 0d 0a 45 | 66 66 65 63 74 20 6f 66 |-----..E|ffect of|
|000008a0| 20 4c 6f 77 2d 44 6f 73 | 65 20 4f 72 61 6c 20 43 | Low-Dos|e Oral C|
|000008b0| 6f 6e 74 72 61 63 65 70 | 74 69 76 65 20 6f 6e 20 |ontracep|tive on |
|000008c0| 47 6f 6e 61 64 6f 74 72 | 6f 70 69 6e 73 2c 20 41 |Gonadotr|opins, A|
|000008d0| 6e 64 72 6f 67 65 6e 73 | 2c 20 61 6e 64 20 53 65 |ndrogens|, and Se|
|000008e0| 78 0d 0a 48 6f 72 6d 6f | 6e 65 20 42 69 6e 64 69 |x..Hormo|ne Bindi|
|000008f0| 6e 67 20 47 6c 6f 62 75 | 6c 69 6e 20 69 6e 20 4e |ng Globu|lin in N|
|00000900| 6f 6e 68 69 72 73 75 74 | 65 20 57 6f 6d 65 6e 0d |onhirsut|e Women.|
|00000910| 0a 0d 0a 4d 75 72 70 68 | 79 20 41 41 3b 20 42 75 |...Murph|y AA; Bu|
|00000920| 72 6b 6d 61 6e 20 52 54 | 3b 20 43 72 6f 70 70 20 |rkman RT|; Cropp |
|00000930| 43 53 3b 20 5a 61 63 75 | 72 20 48 41 3b 20 53 6d |CS; Zacu|r HA; Sm|
|00000940| 69 74 68 20 42 53 0d 0a | 28 55 6e 69 76 20 6f 66 |ith BS..|(Univ of|
|00000950| 20 43 61 6c 69 66 6f 72 | 6e 69 61 2c 20 53 61 6e | Califor|nia, San|
|00000960| 20 44 69 65 67 6f 3b 20 | 4a 6f 68 6e 73 20 48 6f | Diego; |Johns Ho|
|00000970| 70 6b 69 6e 73 20 55 6e | 69 76 29 0d 0a 46 65 72 |pkins Un|iv)..Fer|
|00000980| 74 69 6c 20 53 74 65 72 | 69 6c 20 35 33 3a 33 35 |til Ster|il 53:35|
|00000990| 2d 33 39 2c 20 31 39 39 | 30 0d 0a 2d 2d 2d 2d 2d |-39, 199|0..-----|
|000009a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000009f0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 4d 6f |tract...|. Mo|
|00000a00| 73 74 20 63 6f 6d 62 69 | 6e 65 64 20 6f 72 61 6c |st combi|ned oral|
|00000a10| 20 63 6f 6e 74 72 61 63 | 65 70 74 69 76 65 73 20 | contrac|eptives |
|00000a20| 28 4f 43 73 29 20 61 76 | 61 69 6c 61 62 6c 65 20 |(OCs) av|ailable |
|00000a30| 69 6e 20 74 68 65 20 55 | 6e 69 74 65 64 20 53 74 |in the U|nited St|
|00000a40| 61 74 65 73 0d 0a 63 6f | 6e 74 61 69 6e 20 6c 6f |ates..co|ntain lo|
|00000a50| 77 20 64 6f 73 65 73 20 | 28 33 30 2d 33 35 20 6d |w doses |(30-35 m|
|00000a60| 75 5f 67 29 20 6f 66 20 | 65 74 68 69 6e 79 6c 20 |u_g) of |ethinyl |
|00000a70| 65 73 74 72 61 64 69 6f | 6c 20 28 45 45 32 29 2e |estradio|l (EE2).|
|00000a80| 20 20 4f 72 61 6c 0d 0a | 63 6f 6e 74 72 61 63 65 | Oral..|contrace|
|00000a90| 70 74 69 76 65 73 20 63 | 6f 6e 74 61 69 6e 69 6e |ptives c|ontainin|
|00000aa0| 67 20 35 30 2d 38 30 20 | 6d 75 5f 67 20 6f 66 20 |g 50-80 |mu_g of |
|00000ab0| 45 45 32 20 61 72 65 20 | 63 6f 6d 6d 6f 6e 6c 79 |EE2 are |commonly|
|00000ac0| 20 75 73 65 64 20 74 6f | 20 74 72 65 61 74 0d 0a | used to| treat..|
|00000ad0| 69 64 69 6f 70 61 74 68 | 69 63 20 68 69 72 73 75 |idiopath|ic hirsu|
|00000ae0| 74 69 73 6d 20 61 6e 64 | 20 68 69 72 73 75 74 69 |tism and| hirsuti|
|00000af0| 73 6d 20 61 73 73 6f 63 | 69 61 74 65 64 20 77 69 |sm assoc|iated wi|
|00000b00| 74 68 20 68 79 70 65 72 | 61 6e 64 72 6f 67 65 6e |th hyper|androgen|
|00000b10| 65 6d 69 61 2e 0d 0a 48 | 6f 77 65 76 65 72 2c 20 |emia...H|owever, |
|00000b20| 4f 43 73 20 6e 6f 74 20 | 6f 6e 6c 79 20 73 75 70 |OCs not |only sup|
|00000b30| 70 72 65 73 73 20 74 68 | 65 20 61 6e 64 72 6f 67 |press th|e androg|
|00000b40| 65 6e 73 20 6f 66 20 6f | 76 61 72 69 61 6e 20 6f |ens of o|varian o|
|00000b50| 72 69 67 69 6e 2c 20 62 | 75 74 20 61 6c 73 6f 20 |rigin, b|ut also |
|00000b60| 74 68 6f 73 65 0d 0a 6f | 66 20 61 64 72 65 6e 61 |those..o|f adrena|
|00000b70| 6c 20 6f 72 69 67 69 6e | 2e 20 20 54 68 65 20 73 |l origin|. The s|
|00000b80| 68 6f 72 74 2d 20 61 6e | 64 20 6c 6f 6e 67 2d 74 |hort- an|d long-t|
|00000b90| 65 72 6d 20 65 66 66 65 | 63 74 73 20 6f 66 20 61 |erm effe|cts of a|
|00000ba0| 20 6c 6f 77 2d 64 6f 73 | 65 20 4f 43 20 6f 6e 0d | low-dos|e OC on.|
|00000bb0| 0a 6f 76 61 72 69 61 6e | 20 61 6e 64 20 61 64 72 |.ovarian| and adr|
|00000bc0| 65 6e 61 6c 20 66 75 6e | 63 74 69 6f 6e 20 69 6e |enal fun|ction in|
|00000bd0| 20 6e 6f 72 6d 61 6c 20 | 77 6f 6d 65 6e 20 77 65 | normal |women we|
|00000be0| 72 65 20 66 75 72 74 68 | 65 72 20 61 73 73 65 73 |re furth|er asses|
|00000bf0| 73 65 64 2e 0d 0a 20 20 | 20 20 20 54 68 65 20 73 |sed... | The s|
|00000c00| 74 75 64 79 20 73 61 6d | 70 6c 65 20 63 6f 6e 73 |tudy sam|ple cons|
|00000c10| 69 73 74 65 64 20 6f 66 | 20 33 33 20 68 65 61 6c |isted of| 33 heal|
|00000c20| 74 68 79 2c 20 6e 6f 72 | 6d 61 6c 6c 79 20 6d 65 |thy, nor|mally me|
|00000c30| 6e 73 74 72 75 61 74 69 | 6e 67 2c 0d 0a 6e 6f 6e |nstruati|ng,..non|
|00000c40| 68 69 72 73 75 74 65 20 | 77 6f 6d 65 6e 20 61 67 |hirsute |women ag|
|00000c50| 65 64 20 31 38 2d 33 35 | 20 79 65 61 72 73 20 77 |ed 18-35| years w|
|00000c60| 68 6f 20 68 61 64 20 6e | 6f 74 20 72 65 63 65 69 |ho had n|ot recei|
|00000c70| 76 65 64 20 73 74 65 72 | 6f 69 64 73 20 77 69 74 |ved ster|oids wit|
|00000c80| 68 69 6e 20 74 68 65 0d | 0a 6c 61 73 74 20 33 20 |hin the.|.last 3 |
|00000c90| 6d 6f 6e 74 68 73 20 62 | 65 66 6f 72 65 20 74 68 |months b|efore th|
|00000ca0| 65 20 73 74 75 64 79 2e | 20 20 41 20 6c 6f 77 2d |e study.| A low-|
|00000cb0| 64 6f 73 65 20 6d 6f 6e | 6f 70 68 61 73 69 63 20 |dose mon|ophasic |
|00000cc0| 4f 43 20 63 6f 6e 74 61 | 69 6e 69 6e 67 20 33 35 |OC conta|ining 35|
|00000cd0| 20 6d 75 5f 67 0d 0a 6f | 66 20 45 45 32 20 61 6e | mu_g..o|f EE2 an|
|00000ce0| 64 20 31 20 6d 67 20 6f | 66 20 6e 6f 72 65 74 68 |d 1 mg o|f noreth|
|00000cf0| 69 6e 64 72 6f 6e 65 20 | 77 61 73 20 73 74 61 72 |indrone |was star|
|00000d00| 74 65 64 20 77 69 74 68 | 69 6e 20 64 61 79 73 20 |ted with|in days |
|00000d10| 31 2d 35 20 6f 66 20 74 | 68 65 20 6d 65 6e 73 74 |1-5 of t|he menst|
|00000d20| 72 75 61 6c 0d 0a 63 79 | 63 6c 65 2e 20 20 53 65 |rual..cy|cle. Se|
|00000d30| 72 75 6d 20 6c 65 76 65 | 6c 73 20 6f 66 20 6c 75 |rum leve|ls of lu|
|00000d40| 74 65 69 6e 69 7a 69 6e | 67 20 68 6f 72 6d 6f 6e |teinizin|g hormon|
|00000d50| 65 2c 20 66 6f 6c 6c 69 | 63 6c 65 2d 73 74 69 6d |e, folli|cle-stim|
|00000d60| 75 6c 61 74 69 6e 67 20 | 68 6f 72 6d 6f 6e 65 2c |ulating |hormone,|
|00000d70| 0d 0a 74 6f 74 61 6c 20 | 74 65 73 74 6f 73 74 65 |..total |testoste|
|00000d80| 72 6f 6e 65 2c 20 61 6e | 64 72 6f 73 74 65 6e 65 |rone, an|drostene|
|00000d90| 64 69 6f 6e 65 2c 20 64 | 65 68 79 64 72 6f 65 70 |dione, d|ehydroep|
|00000da0| 69 61 6e 64 72 6f 73 74 | 65 72 6f 6e 65 20 73 75 |iandrost|erone su|
|00000db0| 6c 66 61 74 65 20 28 44 | 48 45 41 53 29 2c 0d 0a |lfate (D|HEAS),..|
|00000dc0| 61 6e 64 20 73 65 78 20 | 68 6f 72 6d 6f 6e 65 2d |and sex |hormone-|
|00000dd0| 62 69 6e 64 69 6e 67 20 | 67 6c 6f 62 75 6c 69 6e |binding |globulin|
|00000de0| 20 28 53 4d 42 47 29 2c | 20 77 65 72 65 20 6f 62 | (SMBG),| were ob|
|00000df0| 74 61 69 6e 65 64 20 61 | 74 20 62 61 73 65 6c 69 |tained a|t baseli|
|00000e00| 6e 65 2c 20 61 6e 64 20 | 61 67 61 69 6e 0d 0a 61 |ne, and |again..a|
|00000e10| 74 20 33 2c 20 36 2c 20 | 61 6e 64 20 39 20 6d 6f |t 3, 6, |and 9 mo|
|00000e20| 6e 74 68 73 20 6f 6e 20 | 64 61 79 73 20 31 2d 35 |nths on |days 1-5|
|00000e30| 20 6f 66 20 74 68 65 20 | 4f 43 20 22 63 79 63 6c | of the |OC "cycl|
|00000e40| 65 2e 22 0d 0a 20 20 20 | 20 20 46 6f 6c 6c 69 63 |e.".. | Follic|
|00000e50| 6c 65 2d 73 74 69 6d 75 | 6c 61 74 69 6e 67 20 68 |le-stimu|lating h|
|00000e60| 6f 72 6d 6f 6e 65 20 6c | 65 76 65 6c 73 20 77 65 |ormone l|evels we|
|00000e70| 72 65 20 73 69 67 6e 69 | 66 69 63 61 6e 74 6c 79 |re signi|ficantly|
|00000e80| 20 72 65 64 75 63 65 64 | 20 66 72 6f 6d 0d 0a 62 | reduced| from..b|
|00000e90| 61 73 65 6c 69 6e 65 20 | 61 74 20 33 2c 20 36 2c |aseline |at 3, 6,|
|00000ea0| 20 61 6e 64 20 39 20 6d | 6f 6e 74 68 73 2c 20 77 | and 9 m|onths, w|
|00000eb0| 69 74 68 20 74 68 65 20 | 6d 61 78 69 6d 75 6d 20 |ith the |maximum |
|00000ec0| 73 75 70 70 72 65 73 73 | 69 6f 6e 20 28 36 31 25 |suppress|ion (61%|
|00000ed0| 29 20 6f 63 63 75 72 72 | 69 6e 67 0d 0a 61 74 20 |) occurr|ing..at |
|00000ee0| 33 20 6d 6f 6e 74 68 73 | 2e 20 20 54 68 65 20 6d |3 months|. The m|
|00000ef0| 65 61 6e 20 6c 75 74 65 | 69 6e 69 7a 69 6e 67 20 |ean lute|inizing |
|00000f00| 68 6f 72 6d 6f 6e 65 20 | 6c 65 76 65 6c 20 77 61 |hormone |level wa|
|00000f10| 73 20 6d 61 78 69 6d 61 | 6c 6c 79 20 73 75 70 70 |s maxima|lly supp|
|00000f20| 72 65 73 73 65 64 20 61 | 74 20 33 0d 0a 6d 6f 6e |ressed a|t 3..mon|
|00000f30| 74 68 73 20 62 79 20 33 | 30 25 20 66 72 6f 6d 20 |ths by 3|0% from |
|00000f40| 62 61 73 65 6c 69 6e 65 | 2c 20 77 69 74 68 20 63 |baseline|, with c|
|00000f50| 6f 6e 74 69 6e 75 65 64 | 20 73 75 70 70 72 65 73 |ontinued| suppres|
|00000f60| 73 69 6f 6e 20 73 65 65 | 6e 20 61 74 20 36 20 6d |sion see|n at 6 m|
|00000f70| 6f 6e 74 68 73 20 61 6e | 64 20 39 0d 0a 6d 6f 6e |onths an|d 9..mon|
|00000f80| 74 68 73 2e 20 20 54 68 | 75 73 20 74 68 65 20 64 |ths. Th|us the d|
|00000f90| 65 63 72 65 61 73 65 20 | 69 6e 20 66 6f 6c 6c 69 |ecrease |in folli|
|00000fa0| 63 6c 65 2d 73 74 69 6d | 75 6c 61 74 69 6e 67 20 |cle-stim|ulating |
|00000fb0| 68 6f 72 6d 6f 6e 65 20 | 77 61 73 20 74 77 69 63 |hormone |was twic|
|00000fc0| 65 20 74 68 61 74 20 6f | 66 0d 0a 6c 75 74 65 69 |e that o|f..lutei|
|00000fd0| 6e 69 7a 69 6e 67 20 68 | 6f 72 6d 6f 6e 65 2e 20 |nizing h|ormone. |
|00000fe0| 20 54 68 65 20 6d 65 61 | 6e 20 53 48 42 47 20 6c | The mea|n SHBG l|
|00000ff0| 65 76 65 6c 20 73 68 6f | 77 65 64 20 61 20 73 74 |evel sho|wed a st|
|00001000| 61 74 69 73 74 69 63 61 | 6c 6c 79 20 73 69 67 6e |atistica|lly sign|
|00001010| 69 66 69 63 61 6e 74 0d | 0a 69 6e 63 72 65 61 73 |ificant.|.increas|
|00001020| 65 20 66 72 6f 6d 20 62 | 61 73 65 6c 69 6e 65 20 |e from b|aseline |
|00001030| 61 74 20 33 2c 20 36 2c | 20 61 6e 64 20 39 20 6d |at 3, 6,| and 9 m|
|00001040| 6f 6e 74 68 73 2e 20 20 | 53 65 72 75 6d 20 44 48 |onths. |Serum DH|
|00001050| 45 41 53 20 6c 65 76 65 | 6c 73 20 77 65 72 65 20 |EAS leve|ls were |
|00001060| 61 6c 73 6f 0d 0a 73 69 | 67 6e 69 66 69 63 61 6e |also..si|gnifican|
|00001070| 74 6c 79 20 73 75 70 70 | 72 65 73 73 65 64 20 61 |tly supp|ressed a|
|00001080| 74 20 33 20 6d 6f 6e 74 | 68 73 20 61 6e 64 20 72 |t 3 mont|hs and r|
|00001090| 65 6d 61 69 6e 65 64 20 | 73 6f 20 61 74 20 36 20 |emained |so at 6 |
|000010a0| 6d 6f 6e 74 68 73 20 61 | 6e 64 20 39 20 6d 6f 6e |months a|nd 9 mon|
|000010b0| 74 68 73 0d 0a 28 46 69 | 67 20 31 35 2d 36 29 2e |ths..(Fi|g 15-6).|
|000010c0| 20 20 53 65 72 75 6d 20 | 61 6e 64 72 6f 73 74 65 | Serum |androste|
|000010d0| 6e 65 64 69 6f 6e 65 20 | 6c 65 76 65 6c 73 20 61 |nedione |levels a|
|000010e0| 74 20 33 2c 20 36 2c 20 | 61 6e 64 20 39 20 6d 6f |t 3, 6, |and 9 mo|
|000010f0| 6e 74 68 73 20 64 69 64 | 20 6e 6f 74 20 64 69 66 |nths did| not dif|
|00001100| 66 65 72 0d 0a 73 69 67 | 6e 69 66 69 63 61 6e 74 |fer..sig|nificant|
|00001110| 6c 79 20 66 72 6f 6d 20 | 62 61 73 65 6c 69 6e 65 |ly from |baseline|
|00001120| 20 76 61 6c 75 65 73 2e | 20 20 53 65 72 75 6d 20 | values.| Serum |
|00001130| 74 6f 74 61 6c 20 74 65 | 73 74 6f 73 74 65 72 6f |total te|stostero|
|00001140| 6e 65 20 6c 65 76 65 6c | 73 20 77 65 72 65 0d 0a |ne level|s were..|
|00001150| 73 69 67 6e 69 66 69 63 | 61 6e 74 6c 79 20 64 65 |signific|antly de|
|00001160| 63 72 65 61 73 65 64 20 | 61 74 20 33 2c 20 36 2c |creased |at 3, 6,|
|00001170| 20 61 6e 64 20 39 20 6d | 6f 6e 74 68 73 20 77 68 | and 9 m|onths wh|
|00001180| 65 6e 20 63 6f 6d 70 61 | 72 65 64 20 77 69 74 68 |en compa|red with|
|00001190| 20 62 61 73 65 6c 69 6e | 65 0d 0a 76 61 6c 75 65 | baselin|e..value|
|000011a0| 73 2e 20 20 41 20 6c 6f | 77 2d 64 6f 73 65 20 6d |s. A lo|w-dose m|
|000011b0| 6f 6e 6f 70 68 61 73 69 | 63 20 4f 43 20 73 69 67 |onophasi|c OC sig|
|000011c0| 6e 69 66 69 63 61 6e 74 | 6c 79 20 73 75 70 70 72 |nificant|ly suppr|
|000011d0| 65 73 73 65 73 20 73 65 | 72 75 6d 0d 0a 69 6d 6d |esses se|rum..imm|
|000011e0| 75 6e 6f 72 65 61 63 74 | 69 76 65 20 67 6f 6e 61 |unoreact|ive gona|
|000011f0| 64 6f 74 72 6f 70 69 6e | 20 6c 65 76 65 6c 73 20 |dotropin| levels |
|00001200| 69 6e 20 6e 6f 72 6d 61 | 6c 6c 79 20 6d 65 6e 73 |in norma|lly mens|
|00001210| 74 72 75 61 74 69 6e 67 | 2c 20 6e 6f 6e 68 69 72 |truating|, nonhir|
|00001220| 73 75 74 65 20 77 6f 6d | 65 6e 0d 0a 77 68 65 6e |sute wom|en..when|
|00001230| 20 63 6f 6d 70 61 72 65 | 64 20 77 69 74 68 20 74 | compare|d with t|
|00001240| 68 65 20 65 61 72 6c 79 | 20 66 6f 6c 6c 69 63 75 |he early| follicu|
|00001250| 6c 61 72 20 70 68 61 73 | 65 2e 0d 0a 0d 0a 50 6f |lar phas|e.....Po|
|00001260| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00001270| 20 20 20 46 6f 72 20 61 | 6c 6c 20 6f 66 20 74 68 | For a|ll of th|
|00001280| 65 20 72 65 61 73 6f 6e | 73 20 73 74 61 74 65 64 |e reason|s stated|
|00001290| 20 69 6e 20 74 68 69 73 | 20 61 72 74 69 63 6c 65 | in this| article|
|000012a0| 2c 20 6c 6f 77 2d 64 6f | 73 65 2c 20 6d 6f 6e 6f |, low-do|se, mono|
|000012b0| 70 68 61 73 69 63 2c 20 | 4f 43 73 0d 0a 73 68 6f |phasic, |OCs..sho|
|000012c0| 75 6c 64 20 62 65 20 74 | 68 65 20 69 6e 69 74 69 |uld be t|he initi|
|000012d0| 61 6c 20 74 72 65 61 74 | 6d 65 6e 74 20 66 6f 72 |al treat|ment for|
|000012e0| 20 77 6f 6d 65 6e 20 77 | 69 74 68 20 68 69 72 73 | women w|ith hirs|
|000012f0| 75 74 69 73 6d 20 6f 66 | 20 6f 76 61 72 69 61 6e |utism of| ovarian|
|00001300| 20 6f 72 0d 0a 63 6f 6d | 62 69 6e 65 64 20 6f 76 | or..com|bined ov|
|00001310| 61 72 69 61 6e 20 61 6e | 64 20 61 64 72 65 6e 61 |arian an|d adrena|
|00001320| 6c 20 6f 72 69 67 69 6e | 2e 20 20 49 6e 20 61 64 |l origin|. In ad|
|00001330| 64 69 74 69 6f 6e 20 74 | 6f 20 73 75 70 70 72 65 |dition t|o suppre|
|00001340| 73 73 69 6e 67 20 4c 42 | 0d 0a 6c 75 74 65 69 6e |ssing LB|..lutein|
|00001350| 69 7a 69 6e 67 20 68 6f | 72 6d 6f 6e 65 20 77 69 |izing ho|rmone wi|
|00001360| 74 68 20 63 6f 6e 63 6f | 6d 69 74 61 6e 74 20 73 |th conco|mitant s|
|00001370| 75 70 70 72 65 73 73 69 | 6f 6e 20 6f 66 20 74 65 |uppressi|on of te|
|00001380| 73 74 6f 73 74 65 72 6f | 6e 65 2c 20 74 68 65 20 |stostero|ne, the |
|00001390| 69 6e 63 72 65 61 73 65 | 0d 0a 69 6e 20 53 48 42 |increase|..in SHB|
|000013a0| 47 20 62 69 6e 64 73 20 | 6d 6f 72 65 20 6f 66 20 |G binds |more of |
|000013b0| 74 68 65 20 63 69 72 63 | 75 6c 61 74 69 6e 67 20 |the circ|ulating |
|000013c0| 74 65 73 74 6f 73 74 65 | 72 6f 6e 65 20 73 6f 20 |testoste|rone so |
|000013d0| 74 68 61 74 20 6c 65 73 | 73 20 6f 66 20 69 74 20 |that les|s of it |
|000013e0| 69 73 0d 0a 61 63 74 69 | 76 65 2e 20 20 49 6e 20 |is..acti|ve. In |
|000013f0| 61 64 64 69 74 69 6f 6e | 2c 20 4f 43 73 20 61 6c |addition|, OCs al|
|00001400| 73 6f 20 73 75 70 70 72 | 65 73 73 20 61 64 72 65 |so suppr|ess adre|
|00001410| 6e 61 6c 20 61 6e 64 72 | 6f 67 65 6e 20 73 65 63 |nal andr|ogen sec|
|00001420| 72 65 74 69 6f 6e 20 74 | 6f 20 73 6f 6d 65 0d 0a |retion t|o some..|
|00001430| 64 65 67 72 65 65 2c 20 | 61 6e 64 20 69 74 20 69 |degree, |and it i|
|00001440| 73 20 6e 6f 74 20 6e 65 | 63 65 73 73 61 72 79 20 |s not ne|cessary |
|00001450| 74 6f 20 61 64 64 20 64 | 65 78 61 6d 65 74 68 61 |to add d|exametha|
|00001460| 73 6f 6e 65 20 75 6e 6c | 65 73 73 20 44 48 45 41 |sone unl|ess DHEA|
|00001470| 53 20 6c 65 76 65 6c 73 | 20 61 72 65 0d 0a 6d 6f |S levels| are..mo|
|00001480| 64 65 72 61 74 65 6c 79 | 20 65 6c 65 76 61 74 65 |derately| elevate|
|00001490| 64 20 28 61 62 6f 76 65 | 20 35 20 6d 75 5f 67 2f |d (above| 5 mu_g/|
|000014a0| 64 4c 29 2e 2d 2d 44 2e | 52 2e 20 4d 69 73 68 65 |dL).--D.|R. Mishe|
|000014b0| 6c 6c 2c 20 4a 72 2e 2c | 20 4d 2e 44 2e 0d 0a 24 |ll, Jr.,| M.D...$|
|000014c0| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 30 32 37 |Unique_I|D{YRB027|
|000014d0| 30 31 7d 0d 0a 24 54 69 | 74 6c 65 7b 45 66 66 65 |01}..$Ti|tle{Effe|
|000014e0| 63 74 20 6f 66 20 4c 65 | 75 70 72 6f 6c 69 64 65 |ct of Le|uprolide|
|000014f0| 20 61 6e 64 20 44 65 78 | 61 6d 65 74 68 61 73 6f | and Dex|amethaso|
|00001500| 6e 65 20 6f 6e 20 48 61 | 69 72 20 47 72 6f 77 74 |ne on Ha|ir Growt|
|00001510| 68 20 61 6e 64 20 48 6f | 72 6d 6f 6e 65 0d 0a 4c |h and Ho|rmone..L|
|00001520| 65 76 65 6c 73 20 69 6e | 20 48 69 72 73 75 74 65 |evels in| Hirsute|
|00001530| 20 57 6f 6d 65 6e 3a 20 | 20 54 68 65 20 52 65 6c | Women: | The Rel|
|00001540| 61 74 69 76 65 20 49 6d | 70 6f 72 74 61 6e 63 65 |ative Im|portance|
|00001550| 20 6f 66 20 74 68 65 20 | 4f 76 61 72 79 20 61 6e | of the |Ovary an|
|00001560| 64 20 74 68 65 20 41 64 | 72 65 6e 61 6c 0d 0a 69 |d the Ad|renal..i|
|00001570| 6e 20 74 68 65 20 50 61 | 74 68 6f 67 65 6e 65 73 |n the Pa|thogenes|
|00001580| 69 73 20 6f 66 20 48 69 | 72 73 75 74 69 73 6d 7d |is of Hi|rsutism}|
|00001590| 0d 0a 24 41 75 74 68 6f | 72 7b 0d 0a 52 69 74 74 |..$Autho|r{..Ritt|
|000015a0| 6d 61 73 74 65 72 2c 20 | 52 53 0d 0a 54 68 6f 6d |master, |RS..Thom|
|000015b0| 70 73 6f 6e 2c 20 44 4c | 7d 0d 0a 24 41 66 66 69 |pson, DL|}..$Affi|
|000015c0| 6c 69 61 74 69 6f 6e 7b | 44 61 6c 68 6f 75 73 69 |liation{|Dalhousi|
|000015d0| 65 20 55 6e 69 76 2c 20 | 48 61 6c 69 66 61 78 2c |e Univ, |Halifax,|
|000015e0| 20 4e 53 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 4a | NS}..$J|ournal{J|
|000015f0| 20 43 6c 69 6e 20 45 6e | 64 6f 63 72 69 6e 6f 6c | Clin En|docrinol|
|00001600| 20 4d 65 74 61 62 7d 0d | 0a 24 56 6f 6c 75 6d 65 | Metab}.|.$Volume|
|00001610| 7b 37 30 7d 0d 0a 24 50 | 61 67 65 7b 31 30 39 36 |{70}..$P|age{1096|
|00001620| 2d 31 31 30 32 7d 0d 0a | 24 44 61 74 65 7b 31 39 |-1102}..|$Date{19|
|00001630| 39 30 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 31 |90}..$YB|Vol{1991|
|00001640| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4f 62 | Year Bo|ok of Ob|
|00001650| 73 74 65 74 72 69 63 73 | 20 61 6e 64 20 47 79 6e |stetrics| and Gyn|
|00001660| 65 63 6f 6c 6f 67 79 7d | 0d 0a 24 43 68 61 70 74 |ecology}|..$Chapt|
|00001670| 65 72 7b 31 35 2d 31 31 | 7d 0d 0a 24 59 42 45 64 |er{15-11|}..$YBEd|
|00001680| 69 74 6f 72 7b 44 72 73 | 2e 20 4d 69 73 68 65 6c |itor{Drs|. Mishel|
|00001690| 6c 2c 20 4b 69 72 73 63 | 68 62 61 75 6d 2c 20 61 |l, Kirsc|hbaum, a|
|000016a0| 6e 64 20 4d 6f 72 72 6f | 77 7d 0d 0a 24 54 61 62 |nd Morro|w}..$Tab|
|000016b0| 6c 65 7b 54 61 62 6c 65 | 20 4f 6d 69 74 74 65 64 |le{Table| Omitted|
|000016c0| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|000016d0| 44 2e 52 2e 20 4d 69 73 | 68 65 6c 6c 2c 20 4a 72 |D.R. Mis|hell, Jr|
|000016e0| 2e 2c 20 4d 2e 44 2e 7d | 0d 0a 0d 0a 43 6f 70 79 |., M.D.}|....Copy|
|000016f0| 72 69 67 68 74 20 28 43 | 29 20 59 65 61 72 20 42 |right (C|) Year B|
|00001700| 6f 6f 6b 20 4d 65 64 69 | 63 61 6c 20 50 75 62 6c |ook Medi|cal Publ|
|00001710| 69 73 68 65 72 73 2c 20 | 49 6e 63 2e 20 31 39 39 |ishers, |Inc. 199|
|00001720| 31 0d 0a 0d 0a 31 39 39 | 31 20 59 65 61 72 20 42 |1....199|1 Year B|
|00001730| 6f 6f 6b 20 6f 66 20 4f | 62 73 74 65 74 72 69 63 |ook of O|bstetric|
|00001740| 73 20 61 6e 64 20 47 79 | 6e 65 63 6f 6c 6f 67 79 |s and Gy|necology|
|00001750| 0d 0a 0d 0a 47 79 6e 65 | 63 6f 6c 6f 67 79 0d 0a |....Gyne|cology..|
|00001760| 0d 0a 43 68 61 70 74 65 | 72 20 31 35 20 2d 2d 20 |..Chapte|r 15 -- |
|00001770| 45 6e 64 6f 63 72 69 6e | 6f 6c 6f 67 79 0d 0a 0d |Endocrin|ology...|
|00001780| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00001790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000017d0| 0a 45 66 66 65 63 74 20 | 6f 66 20 4c 65 75 70 72 |.Effect |of Leupr|
|000017e0| 6f 6c 69 64 65 20 61 6e | 64 20 44 65 78 61 6d 65 |olide an|d Dexame|
|000017f0| 74 68 61 73 6f 6e 65 20 | 6f 6e 20 48 61 69 72 20 |thasone |on Hair |
|00001800| 47 72 6f 77 74 68 20 61 | 6e 64 20 48 6f 72 6d 6f |Growth a|nd Hormo|
|00001810| 6e 65 20 4c 65 76 65 6c | 73 20 69 6e 0d 0a 48 69 |ne Level|s in..Hi|
|00001820| 72 73 75 74 65 20 57 6f | 6d 65 6e 3a 20 20 54 68 |rsute Wo|men: Th|
|00001830| 65 20 52 65 6c 61 74 69 | 76 65 20 49 6d 70 6f 72 |e Relati|ve Impor|
|00001840| 74 61 6e 63 65 20 6f 66 | 20 74 68 65 20 4f 76 61 |tance of| the Ova|
|00001850| 72 79 20 61 6e 64 20 74 | 68 65 20 41 64 72 65 6e |ry and t|he Adren|
|00001860| 61 6c 20 69 6e 20 74 68 | 65 0d 0a 50 61 74 68 6f |al in th|e..Patho|
|00001870| 67 65 6e 65 73 69 73 20 | 6f 66 20 48 69 72 73 75 |genesis |of Hirsu|
|00001880| 74 69 73 6d 0d 0a 0d 0a | 52 69 74 74 6d 61 73 74 |tism....|Rittmast|
|00001890| 65 72 20 52 53 3b 20 54 | 68 6f 6d 70 73 6f 6e 20 |er RS; T|hompson |
|000018a0| 44 4c 0d 0a 28 44 61 6c | 68 6f 75 73 69 65 20 55 |DL..(Dal|housie U|
|000018b0| 6e 69 76 2c 20 48 61 6c | 69 66 61 78 2c 20 4e 53 |niv, Hal|ifax, NS|
|000018c0| 29 0d 0a 4a 20 43 6c 69 | 6e 20 45 6e 64 6f 63 72 |)..J Cli|n Endocr|
|000018d0| 69 6e 6f 6c 20 4d 65 74 | 61 62 20 37 30 3a 31 30 |inol Met|ab 70:10|
|000018e0| 39 36 2d 31 31 30 32 2c | 20 31 39 39 30 0d 0a 2d |96-1102,| 1990..-|
|000018f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00001940| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00001950| 20 20 48 69 72 73 75 74 | 69 73 6d 20 72 65 73 75 | Hirsut|ism resu|
|00001960| 6c 74 73 20 66 72 6f 6d | 20 65 78 63 65 73 73 20 |lts from| excess |
|00001970| 61 6e 64 72 6f 67 65 6e | 20 70 72 6f 64 75 63 74 |androgen| product|
|00001980| 69 6f 6e 20 66 72 6f 6d | 20 74 68 65 20 6f 76 61 |ion from| the ova|
|00001990| 72 69 65 73 20 61 6e 64 | 0d 0a 61 64 72 65 6e 61 |ries and|..adrena|
|000019a0| 6c 20 67 6c 61 6e 64 73 | 20 6f 72 20 69 6e 63 72 |l glands| or incr|
|000019b0| 65 61 73 65 64 20 61 6e | 64 72 6f 67 65 6e 20 73 |eased an|drogen s|
|000019c0| 6b 69 6e 20 73 65 6e 73 | 69 74 69 76 69 74 79 2c |kin sens|itivity,|
|000019d0| 20 6f 72 20 62 6f 74 68 | 2e 20 20 4c 6f 6e 67 2d | or both|. Long-|
|000019e0| 61 63 74 69 6e 67 0d 0a | 67 6f 6e 61 64 6f 74 72 |acting..|gonadotr|
|000019f0| 6f 70 69 6e 2d 72 65 6c | 65 61 73 69 6e 67 20 68 |opin-rel|easing h|
|00001a00| 6f 72 6d 6f 6e 65 20 28 | 47 6e 52 48 29 20 61 67 |ormone (|GnRH) ag|
|00001a10| 6f 6e 69 73 74 73 20 73 | 75 63 68 20 61 73 20 6c |onists s|uch as l|
|00001a20| 65 75 70 72 6f 6c 69 64 | 65 20 73 65 6c 65 63 74 |euprolid|e select|
|00001a30| 69 76 65 6c 79 0d 0a 73 | 75 70 70 72 65 73 73 20 |ively..s|uppress |
|00001a40| 6f 76 61 72 69 61 6e 20 | 73 74 65 72 6f 69 64 20 |ovarian |steroid |
|00001a50| 70 72 6f 64 75 63 74 69 | 6f 6e 20 69 6e 20 77 6f |producti|on in wo|
|00001a60| 6d 65 6e 20 77 69 74 68 | 20 68 69 72 73 75 74 69 |men with| hirsuti|
|00001a70| 73 6d 2e 20 20 54 6f 20 | 65 76 61 6c 75 61 74 65 |sm. To |evaluate|
|00001a80| 20 74 68 65 0d 0a 6f 76 | 61 72 69 61 6e 20 61 6e | the..ov|arian an|
|00001a90| 64 20 61 64 72 65 6e 61 | 6c 20 63 6f 6e 74 72 69 |d adrena|l contri|
|00001aa0| 62 75 74 69 6f 6e 73 20 | 74 6f 20 61 6e 64 72 6f |butions |to andro|
|00001ab0| 67 65 6e 20 70 72 6f 64 | 75 63 74 69 6f 6e 20 61 |gen prod|uction a|
|00001ac0| 6e 64 20 68 61 69 72 20 | 67 72 6f 77 74 68 2c 20 |nd hair |growth, |
|00001ad0| 31 30 0d 0a 68 69 72 73 | 75 74 65 20 77 6f 6d 65 |10..hirs|ute wome|
|00001ae0| 6e 20 77 69 74 68 20 70 | 6f 6c 79 63 79 73 74 69 |n with p|olycysti|
|00001af0| 63 20 6f 76 61 72 69 61 | 6e 20 73 79 6e 64 72 6f |c ovaria|n syndro|
|00001b00| 6d 65 20 28 50 43 4f 29 | 20 61 6e 64 20 39 20 68 |me (PCO)| and 9 h|
|00001b10| 69 72 73 75 74 65 20 77 | 6f 6d 65 6e 20 77 69 74 |irsute w|omen wit|
|00001b20| 68 0d 0a 69 64 69 6f 70 | 61 74 68 69 63 20 68 69 |h..idiop|athic hi|
|00001b30| 72 73 75 74 69 73 6d 20 | 28 49 48 29 20 68 61 64 |rsutism |(IH) had|
|00001b40| 20 73 65 6c 65 63 74 69 | 76 65 20 6f 76 61 72 69 | selecti|ve ovari|
|00001b50| 61 6e 20 73 75 70 70 72 | 65 73 73 69 6f 6e 20 77 |an suppr|ession w|
|00001b60| 69 74 68 20 6c 65 75 70 | 72 6f 6c 69 64 65 0d 0a |ith leup|rolide..|
|00001b70| 66 6f 72 20 35 2d 36 20 | 6d 6f 6e 74 68 73 2e 20 |for 5-6 |months. |
|00001b80| 20 54 68 65 79 20 74 68 | 65 6e 20 77 65 72 65 20 | They th|en were |
|00001b90| 61 73 73 69 67 6e 65 64 | 20 72 61 6e 64 6f 6d 6c |assigned| randoml|
|00001ba0| 79 20 74 6f 20 72 65 63 | 65 69 76 65 20 64 65 78 |y to rec|eive dex|
|00001bb0| 61 6d 65 74 68 61 73 6f | 6e 65 20 6f 72 0d 0a 70 |amethaso|ne or..p|
|00001bc0| 6c 61 63 65 62 6f 2c 20 | 69 6e 20 61 64 64 69 74 |lacebo, |in addit|
|00001bd0| 69 6f 6e 20 74 6f 20 6c | 65 75 70 72 6f 6c 69 64 |ion to l|euprolid|
|00001be0| 65 2c 20 66 6f 72 20 34 | 20 6d 6f 72 65 20 6d 6f |e, for 4| more mo|
|00001bf0| 6e 74 68 73 2e 0d 0a 20 | 20 20 20 20 44 75 72 69 |nths... | Duri|
|00001c00| 6e 67 20 74 68 65 20 69 | 6e 69 74 69 61 6c 20 74 |ng the i|nitial t|
|00001c10| 72 65 61 74 6d 65 6e 74 | 20 70 65 72 69 6f 64 2c |reatment| period,|
|00001c20| 20 74 68 65 20 74 65 73 | 74 6f 73 74 65 72 6f 6e | the tes|tosteron|
|00001c30| 65 20 6c 65 76 65 6c 20 | 64 72 6f 70 70 65 64 20 |e level |dropped |
|00001c40| 62 79 0d 0a 35 34 25 20 | 69 6e 20 74 68 65 20 77 |by..54% |in the w|
|00001c50| 6f 6d 65 6e 20 77 69 74 | 68 20 50 43 4f 20 61 6e |omen wit|h PCO an|
|00001c60| 64 20 62 79 20 33 36 25 | 20 69 6e 20 74 68 6f 73 |d by 36%| in thos|
|00001c70| 65 20 77 69 74 68 20 49 | 48 2e 20 20 41 6e 64 72 |e with I|H. Andr|
|00001c80| 6f 73 74 65 6e 65 64 69 | 6f 6e 65 0d 0a 61 63 74 |ostenedi|one..act|
|00001c90| 69 76 69 74 79 20 64 72 | 6f 70 70 65 64 20 62 79 |ivity dr|opped by|
|00001ca0| 20 35 33 25 20 69 6e 20 | 77 6f 6d 65 6e 20 77 69 | 53% in |women wi|
|00001cb0| 74 68 20 50 43 4f 20 61 | 6e 64 20 33 31 25 20 69 |th PCO a|nd 31% i|
|00001cc0| 6e 20 74 68 6f 73 65 20 | 77 69 74 68 20 49 48 2e |n those |with IH.|
|00001cd0| 0d 0a 41 6e 64 72 6f 73 | 74 61 6e 65 64 69 6f 6c |..Andros|tanediol|
|00001ce0| 20 67 6c 75 63 75 72 6f | 6e 69 64 65 20 61 63 74 | glucuro|nide act|
|00001cf0| 69 76 69 74 79 20 64 65 | 63 72 65 61 73 65 64 20 |ivity de|creased |
|00001d00| 62 79 20 31 34 25 20 61 | 6e 64 20 37 25 20 69 6e |by 14% a|nd 7% in|
|00001d10| 20 50 43 4f 20 61 6e 64 | 20 49 48 2c 0d 0a 72 65 | PCO and| IH,..re|
|00001d20| 73 70 65 63 74 69 76 65 | 6c 79 2e 20 20 54 68 65 |spective|ly. The|
|00001d30| 20 64 65 68 79 64 72 6f | 65 70 69 61 6e 64 72 6f | dehydro|epiandro|
|00001d40| 73 74 65 72 6f 6e 65 20 | 73 75 6c 66 61 74 65 20 |sterone |sulfate |
|00001d50| 28 44 48 45 41 53 29 20 | 6c 65 76 65 6c 20 64 69 |(DHEAS) |level di|
|00001d60| 64 20 6e 6f 74 0d 0a 63 | 68 61 6e 67 65 2e 20 20 |d not..c|hange. |
|00001d70| 41 6c 74 68 6f 75 67 68 | 20 69 6e 69 74 69 61 6c |Although| initial|
|00001d80| 20 73 65 72 75 6d 20 61 | 6e 64 72 6f 67 65 6e 20 | serum a|ndrogen |
|00001d90| 6c 65 76 65 6c 73 20 77 | 65 72 65 20 68 69 67 68 |levels w|ere high|
|00001da0| 65 72 20 69 6e 20 77 6f | 6d 65 6e 20 77 69 74 68 |er in wo|men with|
|00001db0| 20 50 43 4f 0d 0a 74 68 | 61 6e 20 69 6e 20 74 68 | PCO..th|an in th|
|00001dc0| 6f 73 65 20 77 69 74 68 | 20 49 48 2c 20 74 68 65 |ose with| IH, the|
|00001dd0| 79 20 77 65 72 65 20 73 | 69 6d 69 6c 61 72 20 61 |y were s|imilar a|
|00001de0| 66 74 65 72 20 6f 76 61 | 72 69 61 6e 20 73 75 70 |fter ova|rian sup|
|00001df0| 70 72 65 73 73 69 6f 6e | 20 69 6e 20 62 6f 74 68 |pression| in both|
|00001e00| 0d 0a 67 72 6f 75 70 73 | 2e 20 20 41 66 74 65 72 |..groups|. After|
|00001e10| 20 73 75 70 70 72 65 73 | 73 69 6f 6e 2c 20 74 68 | suppres|sion, th|
|00001e20| 65 20 61 6e 64 72 6f 73 | 74 61 6e 65 64 69 6f 6c |e andros|tanediol|
|00001e30| 20 67 6c 75 63 75 72 6f | 6e 69 64 65 20 6c 65 76 | glucuro|nide lev|
|00001e40| 65 6c 20 77 61 73 0d 0a | 63 6f 72 72 65 6c 61 74 |el was..|correlat|
|00001e50| 65 64 20 6d 6f 72 65 20 | 63 6f 6e 73 69 73 74 65 |ed more |consiste|
|00001e60| 6e 74 6c 79 20 77 69 74 | 68 20 74 65 73 74 6f 73 |ntly wit|h testos|
|00001e70| 74 65 72 6f 6e 65 20 61 | 6e 64 20 61 6e 64 72 6f |terone a|nd andro|
|00001e80| 73 74 65 6e 65 64 69 6f | 6e 65 20 6c 65 76 65 6c |stenedio|ne level|
|00001e90| 73 20 74 68 61 6e 0d 0a | 44 48 45 41 73 2e 20 20 |s than..|DHEAs. |
|00001ea0| 54 68 69 73 20 73 75 67 | 67 65 73 74 73 20 74 68 |This sug|gests th|
|00001eb0| 61 74 20 61 6e 64 72 6f | 73 74 61 6e 65 64 69 6f |at andro|stanedio|
|00001ec0| 6c 20 67 6c 75 63 75 72 | 6f 6e 69 64 65 2c 20 64 |l glucur|onide, d|
|00001ed0| 65 72 69 76 65 64 20 70 | 72 69 6d 61 72 69 6c 79 |erived p|rimarily|
|00001ee0| 20 66 72 6f 6d 0d 0a 61 | 64 72 65 6e 61 6c 20 70 | from..a|drenal p|
|00001ef0| 72 65 63 75 72 73 6f 72 | 73 2c 20 6d 69 67 68 74 |recursor|s, might|
|00001f00| 20 62 65 20 61 20 62 65 | 74 74 65 72 20 6d 61 72 | be a be|tter mar|
|00001f10| 6b 65 72 20 74 68 61 6e | 20 44 48 45 41 53 20 6f |ker than| DHEAS o|
|00001f20| 66 20 61 64 72 65 6e 61 | 6c 20 61 6e 64 72 6f 67 |f adrena|l androg|
|00001f30| 65 6e 0d 0a 73 65 63 72 | 65 74 69 6f 6e 2e 0d 0a |en..secr|etion...|
|00001f40| 20 20 20 20 20 48 61 69 | 72 20 67 72 6f 77 74 68 | Hai|r growth|
|00001f50| 20 72 61 74 65 73 20 64 | 65 63 6c 69 6e 65 64 20 | rates d|eclined |
|00001f60| 62 79 20 33 37 25 20 69 | 6e 20 77 6f 6d 65 6e 20 |by 37% i|n women |
|00001f70| 77 69 74 68 20 50 43 4f | 20 61 6e 64 20 62 79 20 |with PCO| and by |
|00001f80| 31 34 25 20 69 6e 20 77 | 6f 6d 65 6e 0d 0a 77 69 |14% in w|omen..wi|
|00001f90| 74 68 20 49 48 2e 20 20 | 43 68 61 6e 67 65 20 69 |th IH. |Change i|
|00001fa0| 6e 20 68 61 69 72 20 67 | 72 6f 77 74 68 20 77 61 |n hair g|rowth wa|
|00001fb0| 73 20 63 6f 72 72 65 6c | 61 74 65 64 20 77 69 74 |s correl|ated wit|
|00001fc0| 68 20 63 68 61 6e 67 65 | 73 20 69 6e 20 61 6e 64 |h change|s in and|
|00001fd0| 72 6f 73 74 65 6e 65 64 | 69 6f 6e 65 0d 0a 61 63 |rostened|ione..ac|
|00001fe0| 74 69 76 69 74 79 20 62 | 75 74 20 6e 6f 74 20 77 |tivity b|ut not w|
|00001ff0| 69 74 68 20 63 68 61 6e | 67 65 73 20 69 6e 20 74 |ith chan|ges in t|
|00002000| 65 73 74 6f 73 74 65 72 | 6f 6e 65 2e 20 20 41 66 |estoster|one. Af|
|00002010| 74 65 72 20 64 65 78 61 | 6d 65 74 68 61 73 6f 6e |ter dexa|methason|
|00002020| 65 20 77 61 73 20 61 64 | 64 65 64 2c 0d 0a 74 68 |e was ad|ded,..th|
|00002030| 65 20 6c 65 76 65 6c 73 | 20 6f 66 20 74 65 73 74 |e levels| of test|
|00002040| 6f 73 74 65 72 6f 6e 65 | 2c 20 61 6e 64 72 6f 73 |osterone|, andros|
|00002050| 74 65 6e 65 64 69 6f 6e | 65 2c 20 61 6e 64 20 44 |tenedion|e, and D|
|00002060| 48 45 41 53 20 64 65 63 | 6c 69 6e 65 64 20 74 6f |HEAS dec|lined to|
|00002070| 20 6e 65 61 72 20 6f 72 | 0d 0a 62 65 6c 6f 77 20 | near or|..below |
|00002080| 61 73 73 61 79 20 64 65 | 74 65 63 74 69 6f 6e 20 |assay de|tection |
|00002090| 6c 69 6d 69 74 73 2c 20 | 61 6e 64 20 74 68 65 20 |limits, |and the |
|000020a0| 6c 65 76 65 6c 20 6f 66 | 20 61 6e 64 72 6f 73 74 |level of| androst|
|000020b0| 61 6e 65 64 69 6f 6c 20 | 67 6c 75 63 75 72 6f 6e |anediol |glucuron|
|000020c0| 69 64 65 0d 0a 64 72 6f | 70 70 65 64 20 62 79 20 |ide..dro|pped by |
|000020d0| 38 30 25 20 28 46 69 67 | 20 31 35 2d 37 29 2e 20 |80% (Fig| 15-7). |
|000020e0| 20 48 61 69 72 20 67 72 | 6f 77 74 68 20 72 61 74 | Hair gr|owth rat|
|000020f0| 65 73 20 66 65 6c 6c 20 | 73 6c 69 67 68 74 6c 79 |es fell |slightly|
|00002100| 20 6d 6f 72 65 20 69 6e | 20 77 6f 6d 65 6e 0d 0a | more in| women..|
|00002110| 64 75 72 69 6e 67 20 64 | 65 78 61 6d 65 74 68 61 |during d|exametha|
|00002120| 73 6f 6e 65 20 74 72 65 | 61 74 6d 65 6e 74 20 74 |sone tre|atment t|
|00002130| 68 61 6e 20 64 75 72 69 | 6e 67 20 61 64 6d 69 6e |han duri|ng admin|
|00002140| 69 73 74 72 61 74 69 6f | 6e 20 6f 66 20 70 6c 61 |istratio|n of pla|
|00002150| 63 65 62 6f 2e 0d 0a 20 | 20 20 20 20 54 68 65 20 |cebo... | The |
|00002160| 6f 76 61 72 79 20 69 73 | 20 74 68 65 20 6d 61 6a |ovary is| the maj|
|00002170| 6f 72 20 73 6f 75 72 63 | 65 20 6f 66 20 63 69 72 |or sourc|e of cir|
|00002180| 63 75 6c 61 74 69 6e 67 | 20 74 65 73 74 6f 73 74 |culating| testost|
|00002190| 65 72 6f 6e 65 20 61 6e | 64 0d 0a 61 6e 64 72 6f |erone an|d..andro|
|000021a0| 73 74 65 6e 65 64 69 6f | 6e 65 20 69 6e 20 77 6f |stenedio|ne in wo|
|000021b0| 6d 65 6e 20 77 69 74 68 | 20 50 43 4f 2e 20 20 54 |men with| PCO. T|
|000021c0| 68 65 20 61 64 72 65 6e | 61 6c 20 63 6f 6e 74 72 |he adren|al contr|
|000021d0| 69 62 75 74 65 64 20 61 | 20 73 75 62 73 74 61 6e |ibuted a| substan|
|000021e0| 74 69 61 6c 0d 0a 6d 69 | 6e 6f 72 69 74 79 20 6f |tial..mi|nority o|
|000021f0| 66 20 74 68 65 73 65 20 | 68 6f 72 6d 6f 6e 65 73 |f these |hormones|
|00002200| 20 69 6e 20 77 6f 6d 65 | 6e 20 77 69 74 68 20 50 | in wome|n with P|
|00002210| 43 4f 20 61 6e 64 20 77 | 61 73 20 74 68 65 20 70 |CO and w|as the p|
|00002220| 72 69 6d 61 72 79 20 73 | 6f 75 72 63 65 20 6f 66 |rimary s|ource of|
|00002230| 0d 0a 61 6e 64 72 6f 67 | 65 6e 20 73 65 63 72 65 |..androg|en secre|
|00002240| 74 69 6f 6e 20 69 6e 20 | 74 68 6f 73 65 20 77 69 |tion in |those wi|
|00002250| 74 68 20 49 48 2e 20 20 | 41 64 72 65 6e 61 6c 20 |th IH. |Adrenal |
|00002260| 68 79 70 65 72 61 6e 64 | 72 6f 67 65 6e 69 73 6d |hyperand|rogenism|
|00002270| 20 77 61 73 20 63 6f 6d | 6d 6f 6e 20 69 6e 0d 0a | was com|mon in..|
|00002280| 62 6f 74 68 20 67 72 6f | 75 70 73 2e 20 20 48 61 |both gro|ups. Ha|
|00002290| 69 72 20 67 72 6f 77 74 | 68 20 72 61 74 65 73 20 |ir growt|h rates |
|000022a0| 77 65 72 65 20 62 65 73 | 74 20 63 6f 72 72 65 6c |were bes|t correl|
|000022b0| 61 74 65 64 20 77 69 74 | 68 20 63 68 61 6e 67 65 |ated wit|h change|
|000022c0| 73 20 69 6e 20 73 65 72 | 75 6d 0d 0a 61 6e 64 72 |s in ser|um..andr|
|000022d0| 6f 73 74 65 6e 65 64 69 | 6f 6e 65 20 6c 65 76 65 |ostenedi|one leve|
|000022e0| 6c 73 2e 0d 0a 0d 0a 50 | 6f 73 74 2d 43 6f 6d 6d |ls.....P|ost-Comm|
|000022f0| 65 6e 74 0d 0a 0d 0a 20 | 20 20 20 20 54 68 65 73 |ent.... | Thes|
|00002300| 65 20 77 6f 6d 65 6e 20 | 61 6c 6c 20 68 61 64 20 |e women |all had |
|00002310| 6d 6f 64 65 72 61 74 65 | 20 74 6f 20 73 65 76 65 |moderate| to seve|
|00002320| 72 65 20 68 69 72 73 75 | 74 69 73 6d 2c 20 61 6e |re hirsu|tism, an|
|00002330| 64 20 69 74 20 61 70 70 | 65 61 72 73 20 74 68 61 |d it app|ears tha|
|00002340| 74 20 69 6e 0d 0a 73 75 | 63 68 20 61 20 67 72 6f |t in..su|ch a gro|
|00002350| 75 70 20 74 68 65 72 65 | 20 69 73 20 73 75 62 73 |up there| is subs|
|00002360| 74 61 6e 74 69 61 6c 20 | 61 64 72 65 6e 61 6c 20 |tantial |adrenal |
|00002370| 73 65 63 72 65 74 69 6f | 6e 20 6f 66 20 65 78 63 |secretio|n of exc|
|00002380| 65 73 73 20 61 6e 64 72 | 6f 67 65 6e 73 2e 20 20 |ess andr|ogens. |
|00002390| 41 73 0d 0a 72 65 70 6f | 72 74 65 64 20 69 6e 20 |As..repo|rted in |
|000023a0| 41 62 73 74 72 61 63 74 | 20 31 35 2d 31 30 2c 20 |Abstract| 15-10, |
|000023b0| 74 68 65 20 70 72 69 6d | 61 72 79 20 74 72 65 61 |the prim|ary trea|
|000023c0| 74 6d 65 6e 74 20 6f 66 | 20 68 69 72 73 75 74 69 |tment of| hirsuti|
|000023d0| 73 6d 20 69 73 20 6f 72 | 61 6c 0d 0a 63 6f 6e 74 |sm is or|al..cont|
|000023e0| 72 61 63 65 70 74 69 76 | 65 73 2e 20 20 54 68 65 |raceptiv|es. The|
|000023f0| 73 65 2c 20 69 6e 20 61 | 64 64 69 74 69 6f 6e 20 |se, in a|ddition |
|00002400| 74 6f 20 69 6e 68 69 62 | 69 74 69 6e 67 20 6c 75 |to inhib|iting lu|
|00002410| 74 65 69 6e 69 7a 69 6e | 67 20 68 6f 72 6d 6f 6e |teinizin|g hormon|
|00002420| 65 20 61 6e 64 20 74 68 | 75 73 0d 0a 6f 76 61 72 |e and th|us..ovar|
|00002430| 69 61 6e 20 74 65 73 74 | 6f 73 74 65 72 6f 6e 65 |ian test|osterone|
|00002440| 20 70 72 6f 64 75 63 74 | 69 6f 6e 2c 20 61 6c 73 | product|ion, als|
|00002450| 6f 20 69 6e 63 72 65 61 | 73 65 20 74 68 65 20 6c |o increa|se the l|
|00002460| 65 76 65 6c 20 6f 66 20 | 73 65 78 0d 0a 68 6f 72 |evel of |sex..hor|
|00002470| 6d 6f 6e 65 2d 62 69 6e | 64 69 6e 67 20 67 6c 6f |mone-bin|ding glo|
|00002480| 62 75 6c 69 6e 2c 20 77 | 68 69 63 68 20 69 6e 61 |bulin, w|hich ina|
|00002490| 63 74 69 76 61 74 65 73 | 20 63 69 72 63 75 6c 61 |ctivates| circula|
|000024a0| 74 6f 72 79 20 74 65 73 | 74 6f 73 74 65 72 6f 6e |tory tes|tosteron|
|000024b0| 65 2e 20 20 4f 72 61 6c | 0d 0a 63 6f 6e 74 72 61 |e. Oral|..contra|
|000024c0| 63 65 70 74 69 76 65 73 | 20 61 6c 73 6f 20 73 75 |ceptives| also su|
|000024d0| 70 70 72 65 73 73 20 61 | 64 72 65 6e 61 6c 20 61 |ppress a|drenal a|
|000024e0| 6e 64 72 6f 67 65 6e 20 | 70 72 6f 64 75 63 74 69 |ndrogen |producti|
|000024f0| 6f 6e 2e 20 20 55 73 65 | 20 6f 66 20 61 20 47 6e |on. Use| of a Gn|
|00002500| 52 68 0d 0a 61 67 6f 6e | 69 73 74 20 69 73 20 65 |Rh..agon|ist is e|
|00002510| 78 70 65 6e 73 69 76 65 | 20 61 6e 64 20 63 61 6e |xpensive| and can|
|00002520| 20 72 65 73 75 6c 74 20 | 69 6e 20 62 6f 6e 65 20 | result |in bone |
|00002530| 6c 6f 73 73 20 75 6e 6c | 65 73 73 20 65 78 6f 67 |loss unl|ess exog|
|00002540| 65 6e 6f 75 73 20 65 73 | 74 72 6f 67 65 6e 0d 0a |enous es|trogen..|
|00002550| 74 68 65 72 61 70 79 20 | 69 73 20 67 69 76 65 6e |therapy |is given|
|00002560| 20 63 6f 6e 63 75 72 72 | 65 6e 74 6c 79 2e 20 20 | concurr|ently. |
|00002570| 54 68 75 73 20 69 74 20 | 69 73 20 6f 66 20 75 73 |Thus it |is of us|
|00002580| 65 20 6f 66 20 69 6e 76 | 65 73 74 69 67 61 74 65 |e of inv|estigate|
|00002590| 20 74 68 65 20 72 65 6c | 61 74 69 76 65 0d 0a 6f | the rel|ative..o|
|000025a0| 76 61 72 69 61 6e 20 61 | 6e 64 20 61 64 72 65 6e |varian a|nd adren|
|000025b0| 61 6c 20 63 6f 6d 70 6f | 6e 65 6e 74 73 20 6f 66 |al compo|nents of|
|000025c0| 20 68 79 70 65 72 61 6e | 64 72 6f 67 65 6e 69 73 | hyperan|drogenis|
|000025d0| 6d 20 62 75 74 20 74 68 | 65 73 65 20 74 65 73 74 |m but th|ese test|
|000025e0| 73 20 73 68 6f 75 6c 64 | 20 6e 6f 74 0d 0a 62 65 |s should| not..be|
|000025f0| 20 75 73 65 64 20 66 6f | 72 20 74 68 65 72 61 70 | used fo|r therap|
|00002600| 79 20 6f 66 20 68 69 72 | 73 75 74 69 73 6d 2e 2d |y of hir|sutism.-|
|00002610| 2d 44 2e 52 2e 20 4d 69 | 73 68 65 6c 6c 2c 20 4a |-D.R. Mi|shell, J|
|00002620| 72 2e 2c 20 4d 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |r., M.D.|..$Uniqu|
|00002630| 65 5f 49 44 7b 59 52 42 | 30 32 37 30 32 7d 0d 0a |e_ID{YRB|02702}..|
|00002640| 24 54 69 74 6c 65 7b 32 | 31 2d 48 79 64 72 6f 78 |$Title{2|1-Hydrox|
|00002650| 79 6c 61 73 65 20 44 65 | 66 69 63 69 65 6e 63 79 |ylase De|ficiency|
|00002660| 20 69 6e 20 46 65 6d 61 | 6c 65 20 48 79 70 65 72 | in Fema|le Hyper|
|00002670| 61 6e 64 72 6f 67 65 6e | 69 73 6d 3a 20 20 53 63 |androgen|ism: Sc|
|00002680| 72 65 65 6e 69 6e 67 20 | 61 6e 64 0d 0a 44 69 61 |reening |and..Dia|
|00002690| 67 6e 6f 73 69 73 7d 0d | 0a 24 41 75 74 68 6f 72 |gnosis}.|.$Author|
|000026a0| 7b 0d 0a 41 7a 7a 69 7a | 2c 20 52 0d 0a 5a 61 63 |{..Azziz|, R..Zac|
|000026b0| 75 72 2c 20 48 41 7d 0d | 0a 24 41 66 66 69 6c 69 |ur, HA}.|.$Affili|
|000026c0| 61 74 69 6f 6e 7b 4a 6f | 68 6e 73 20 48 6f 70 6b |ation{Jo|hns Hopk|
|000026d0| 69 6e 73 20 55 6e 69 76 | 7d 0d 0a 24 4a 6f 75 72 |ins Univ|}..$Jour|
|000026e0| 6e 61 6c 7b 4a 20 43 6c | 69 6e 20 45 6e 64 6f 63 |nal{J Cl|in Endoc|
|000026f0| 72 69 6e 6f 6c 20 4d 65 | 74 61 62 7d 0d 0a 24 56 |rinol Me|tab}..$V|
|00002700| 6f 6c 75 6d 65 7b 36 39 | 7d 0d 0a 24 50 61 67 65 |olume{69|}..$Page|
|00002710| 7b 35 37 37 2d 35 38 34 | 7d 0d 0a 24 44 61 74 65 |{577-584|}..$Date|
|00002720| 7b 31 39 38 39 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 |{1989}..|$YBVol{1|
|00002730| 39 39 31 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |991 Year| Book of|
|00002740| 20 4f 62 73 74 65 74 72 | 69 63 73 20 61 6e 64 20 | Obstetr|ics and |
|00002750| 47 79 6e 65 63 6f 6c 6f | 67 79 7d 0d 0a 24 43 68 |Gynecolo|gy}..$Ch|
|00002760| 61 70 74 65 72 7b 31 35 | 2d 31 32 7d 0d 0a 24 59 |apter{15|-12}..$Y|
|00002770| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 4d 69 73 |BEditor{|Drs. Mis|
|00002780| 68 65 6c 6c 2c 20 4b 69 | 72 73 63 68 62 61 75 6d |hell, Ki|rschbaum|
|00002790| 2c 20 61 6e 64 20 4d 6f | 72 72 6f 77 7d 0d 0a 24 |, and Mo|rrow}..$|
|000027a0| 54 61 62 6c 65 7b 7d 0d | 0a 24 43 6f 6d 6d 65 6e |Table{}.|.$Commen|
|000027b0| 74 61 74 6f 72 7b 44 2e | 52 2e 20 4d 69 73 68 65 |tator{D.|R. Mishe|
|000027c0| 6c 6c 2c 20 4a 72 2e 2c | 20 4d 2e 44 2e 7d 0d 0a |ll, Jr.,| M.D.}..|
|000027d0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 43 29 20 |..Copyri|ght (C) |
|000027e0| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|000027f0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|00002800| 63 2e 20 31 39 39 31 0d | 0a 0d 0a 31 39 39 31 20 |c. 1991.|...1991 |
|00002810| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4f 62 73 |Year Boo|k of Obs|
|00002820| 74 65 74 72 69 63 73 20 | 61 6e 64 20 47 79 6e 65 |tetrics |and Gyne|
|00002830| 63 6f 6c 6f 67 79 0d 0a | 0d 0a 47 79 6e 65 63 6f |cology..|..Gyneco|
|00002840| 6c 6f 67 79 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 |logy....|Chapter |
|00002850| 31 35 20 2d 2d 20 45 6e | 64 6f 63 72 69 6e 6f 6c |15 -- En|docrinol|
|00002860| 6f 67 79 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ogy....-|--------|
|00002870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028b0| 2d 2d 2d 2d 2d 0d 0a 32 | 31 2d 48 79 64 72 6f 78 |-----..2|1-Hydrox|
|000028c0| 79 6c 61 73 65 20 44 65 | 66 69 63 69 65 6e 63 79 |ylase De|ficiency|
|000028d0| 20 69 6e 20 46 65 6d 61 | 6c 65 20 48 79 70 65 72 | in Fema|le Hyper|
|000028e0| 61 6e 64 72 6f 67 65 6e | 69 73 6d 3a 20 20 53 63 |androgen|ism: Sc|
|000028f0| 72 65 65 6e 69 6e 67 20 | 61 6e 64 20 44 69 61 67 |reening |and Diag|
|00002900| 6e 6f 73 69 73 0d 0a 0d | 0a 41 7a 7a 69 7a 20 52 |nosis...|.Azziz R|
|00002910| 3b 20 5a 61 63 75 72 20 | 48 41 0d 0a 28 4a 6f 68 |; Zacur |HA..(Joh|
|00002920| 6e 73 20 48 6f 70 6b 69 | 6e 73 20 55 6e 69 76 29 |ns Hopki|ns Univ)|
|00002930| 0d 0a 4a 20 43 6c 69 6e | 20 45 6e 64 6f 63 72 69 |..J Clin| Endocri|
|00002940| 6e 6f 6c 20 4d 65 74 61 | 62 20 36 39 3a 35 37 37 |nol Meta|b 69:577|
|00002950| 2d 35 38 34 2c 20 31 39 | 38 39 0d 0a 2d 2d 2d 2d |-584, 19|89..----|
|00002960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000029a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|000029b0| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 55 |stract..|.. U|
|000029c0| 70 20 74 6f 20 36 25 20 | 6f 66 20 68 79 70 65 72 |p to 6% |of hyper|
|000029d0| 61 6e 64 72 6f 67 65 6e | 69 63 20 77 6f 6d 65 6e |androgen|ic women|
|000029e0| 20 61 72 65 20 61 66 66 | 65 63 74 65 64 20 62 79 | are aff|ected by|
|000029f0| 0d 0a 32 31 2d 68 79 64 | 72 6f 78 79 6c 61 73 65 |..21-hyd|roxylase|
|00002a00| 2d 64 65 66 69 63 69 65 | 6e 74 20 6c 61 74 65 2d |-deficie|nt late-|
|00002a10| 6f 6e 73 65 74 20 61 64 | 72 65 6e 61 6c 20 68 79 |onset ad|renal hy|
|00002a20| 70 65 72 70 6c 61 73 69 | 61 20 28 4c 4f 41 48 29 |perplasi|a (LOAH)|
|00002a30| 2e 20 20 53 63 72 65 65 | 6e 69 6e 67 20 61 6e 64 |. Scree|ning and|
|00002a40| 0d 0a 64 69 61 67 6e 6f | 73 74 69 63 20 63 72 69 |..diagno|stic cri|
|00002a50| 74 65 72 69 61 20 66 6f | 72 20 4c 4f 41 48 20 61 |teria fo|r LOAH a|
|00002a60| 72 65 20 6e 6f 74 20 77 | 65 6c 6c 20 65 73 74 61 |re not w|ell esta|
|00002a70| 62 6c 69 73 68 65 64 2e | 20 20 50 61 74 69 65 6e |blished.| Patien|
|00002a80| 74 73 20 77 69 74 68 20 | 4c 4f 41 48 20 61 72 65 |ts with |LOAH are|
|00002a90| 0d 0a 63 6c 69 6e 69 63 | 61 6c 6c 79 20 69 6e 64 |..clinic|ally ind|
|00002aa0| 69 73 74 69 6e 67 75 69 | 73 68 61 62 6c 65 20 66 |istingui|shable f|
|00002ab0| 72 6f 6d 20 6f 74 68 65 | 72 20 68 79 70 65 72 61 |rom othe|r hypera|
|00002ac0| 6e 64 72 6f 67 65 6e 69 | 63 20 77 6f 6d 65 6e 2e |ndrogeni|c women.|
|00002ad0| 20 20 41 20 70 72 6f 73 | 70 65 63 74 69 76 65 0d | A pros|pective.|
|00002ae0| 0a 73 74 75 64 79 20 77 | 61 73 20 64 6f 6e 65 20 |.study w|as done |
|00002af0| 74 6f 20 64 65 74 65 72 | 6d 69 6e 65 20 74 68 65 |to deter|mine the|
|00002b00| 20 70 72 65 64 69 63 74 | 69 76 65 20 76 61 6c 75 | predict|ive valu|
|00002b10| 65 20 6f 66 20 73 63 72 | 65 65 6e 69 6e 67 20 68 |e of scr|eening h|
|00002b20| 79 70 65 72 61 6e 64 72 | 6f 67 65 6e 69 63 0d 0a |yperandr|ogenic..|
|00002b30| 77 6f 6d 65 6e 20 66 6f | 72 20 4c 4f 41 48 20 77 |women fo|r LOAH w|
|00002b40| 69 74 68 20 61 20 6d 6f | 72 6e 69 6e 67 20 66 6f |ith a mo|rning fo|
|00002b50| 6c 6c 69 63 75 6c 61 72 | 20 70 68 61 73 65 20 62 |llicular| phase b|
|00002b60| 61 73 61 6c 20 31 37 2d | 68 79 64 72 6f 78 79 70 |asal 17-|hydroxyp|
|00002b70| 72 6f 67 65 73 74 65 72 | 6f 6e 65 0d 0a 28 31 37 |rogester|one..(17|
|00002b80| 2d 48 50 29 20 6c 65 76 | 65 6c 20 61 6e 64 20 74 |-HP) lev|el and t|
|00002b90| 6f 20 63 6f 6d 70 61 72 | 65 20 74 68 65 20 76 61 |o compar|e the va|
|00002ba0| 72 69 6f 75 73 20 69 6e | 20 76 69 76 6f 20 65 73 |rious in| vivo es|
|00002bb0| 74 69 6d 61 74 65 73 20 | 6f 66 20 32 31 2d 68 79 |timates |of 21-hy|
|00002bc0| 64 72 6f 78 79 6c 61 73 | 65 0d 0a 61 63 74 69 76 |droxylas|e..activ|
|00002bd0| 69 74 79 20 61 66 74 65 | 72 20 61 64 72 65 6e 61 |ity afte|r adrena|
|00002be0| 6c 20 73 74 69 6d 75 6c | 61 74 69 6f 6e 20 66 6f |l stimul|ation fo|
|00002bf0| 72 20 74 68 65 20 64 69 | 61 67 6e 6f 73 69 73 20 |r the di|agnosis |
|00002c00| 6f 66 20 4c 4f 41 48 2e | 0d 0a 20 20 20 20 20 54 |of LOAH.|.. T|
|00002c10| 77 65 6e 74 79 2d 6f 6e | 65 20 65 75 61 6e 64 72 |wenty-on|e euandr|
|00002c20| 6f 67 65 6e 69 63 20 63 | 6f 6e 74 72 6f 6c 73 20 |ogenic c|ontrols |
|00002c30| 61 6e 64 20 31 36 34 20 | 63 6f 6e 73 65 63 75 74 |and 164 |consecut|
|00002c40| 69 76 65 20 75 6e 73 65 | 6c 65 63 74 65 64 20 70 |ive unse|lected p|
|00002c50| 61 74 69 65 6e 74 73 0d | 0a 77 69 74 68 20 68 69 |atients.|.with hi|
|00002c60| 72 73 75 74 69 73 6d 20 | 6f 72 20 68 79 70 65 72 |rsutism |or hyper|
|00002c70| 61 6e 64 72 6f 67 65 6e | 69 63 20 6f 6c 69 67 6f |androgen|ic oligo|
|00002c80| 6d 65 6e 6f 72 72 68 65 | 61 20 75 6e 64 65 72 77 |menorrhe|a underw|
|00002c90| 65 6e 74 20 61 63 75 74 | 65 20 61 64 72 65 6e 61 |ent acut|e adrena|
|00002ca0| 6c 0d 0a 73 74 69 6d 75 | 6c 61 74 69 6f 6e 20 77 |l..stimu|lation w|
|00002cb0| 69 74 68 20 31 20 6d 67 | 20 6f 66 20 61 64 72 65 |ith 1 mg| of adre|
|00002cc0| 6e 6f 63 6f 72 74 69 63 | 6f 74 72 6f 70 69 6e 20 |nocortic|otropin |
|00002cd0| 68 6f 72 6d 6f 6e 65 20 | 28 41 43 54 48 29 2d 28 |hormone |(ACTH)-(|
|00002ce0| 31 2d 32 34 29 2c 0d 0a | 61 64 6d 69 6e 69 73 74 |1-24),..|administ|
|00002cf0| 65 72 65 64 20 69 6e 20 | 74 68 65 20 6d 6f 72 6e |ered in |the morn|
|00002d00| 69 6e 67 20 74 6f 20 66 | 61 73 74 69 6e 67 20 70 |ing to f|asting p|
|00002d10| 61 74 69 65 6e 74 73 20 | 69 6e 20 74 68 65 20 66 |atients |in the f|
|00002d20| 6f 6c 6c 69 63 75 6c 61 | 72 20 70 68 61 73 65 20 |ollicula|r phase |
|00002d30| 6f 66 0d 0a 74 68 65 69 | 72 20 6d 65 6e 73 74 72 |of..thei|r menstr|
|00002d40| 75 61 6c 20 63 79 63 6c | 65 2e 20 20 54 68 69 72 |ual cycl|e. Thir|
|00002d50| 74 65 65 6e 20 6f 66 20 | 74 68 65 20 31 36 34 20 |teen of |the 164 |
|00002d60| 70 61 74 69 65 6e 74 73 | 20 28 37 2e 39 25 29 20 |patients| (7.9%) |
|00002d70| 68 61 64 20 61 74 20 6c | 65 61 73 74 20 31 0d 0a |had at l|east 1..|
|00002d80| 61 62 6e 6f 72 6d 61 6c | 20 6d 65 61 73 75 72 65 |abnormal| measure|
|00002d90| 6d 65 6e 74 20 6f 66 20 | 32 31 2d 68 79 64 72 6f |ment of |21-hydro|
|00002da0| 78 79 6c 61 73 65 20 61 | 63 74 69 76 69 74 79 2e |xylase a|ctivity.|
|00002db0| 20 20 46 6f 75 72 20 6f | 66 20 74 68 65 73 65 20 | Four o|f these |
|00002dc0| 77 6f 6d 65 6e 20 68 61 | 64 0d 0a 31 37 2d 48 50 |women ha|d..17-HP|
|00002dd0| 20 6c 65 76 65 6c 73 20 | 33 20 74 6f 20 32 30 20 | levels |3 to 20 |
|00002de0| 74 69 6d 65 73 20 61 62 | 6f 76 65 20 74 68 65 20 |times ab|ove the |
|00002df0| 75 70 70 65 72 20 6e 6f | 72 6d 61 6c 20 39 35 74 |upper no|rmal 95t|
|00002e00| 68 20 70 65 72 63 65 6e | 74 69 6c 65 3b 20 74 68 |h percen|tile; th|
|00002e10| 65 79 20 77 65 72 65 0d | 0a 63 6f 6e 73 69 64 65 |ey were.|.conside|
|00002e20| 72 65 64 20 74 6f 20 68 | 61 76 65 20 4c 4f 41 48 |red to h|ave LOAH|
|00002e30| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 33 20 6d 65 |... |The 3 me|
|00002e40| 61 73 75 72 65 73 20 6f | 66 20 32 31 2d 68 79 64 |asures o|f 21-hyd|
|00002e50| 72 6f 78 79 6c 61 73 65 | 20 73 74 75 64 69 65 64 |roxylase| studied|
|00002e60| 2d 2d 74 68 65 20 31 37 | 2d 48 50 20 6c 65 76 65 |--the 17|-HP leve|
|00002e70| 6c 20 33 30 20 6d 69 6e | 75 74 65 73 0d 0a 61 66 |l 30 min|utes..af|
|00002e80| 74 65 72 20 41 43 54 48 | 2c 20 74 68 65 20 63 68 |ter ACTH|, the ch|
|00002e90| 61 6e 67 65 20 69 6e 20 | 31 37 2d 48 50 2c 20 61 |ange in |17-HP, a|
|00002ea0| 6e 64 20 74 68 65 20 73 | 75 6d 6d 65 64 20 72 61 |nd the s|ummed ra|
|00002eb0| 74 65 20 6f 66 20 63 68 | 61 6e 67 65 20 69 6e 20 |te of ch|ange in |
|00002ec0| 31 37 2d 48 50 20 61 6e | 64 0d 0a 70 72 6f 67 65 |17-HP an|d..proge|
|00002ed0| 73 74 65 72 6f 6e 65 2d | 2d 63 6c 65 61 72 6c 79 |sterone-|-clearly|
|00002ee0| 20 64 69 66 66 65 72 65 | 6e 74 69 61 74 65 64 20 | differe|ntiated |
|00002ef0| 74 68 65 20 4c 4f 41 48 | 20 70 61 74 69 65 6e 74 |the LOAH| patient|
|00002f00| 73 20 66 72 6f 6d 20 61 | 6c 6c 20 6f 74 68 65 72 |s from a|ll other|
|00002f10| 73 2e 20 20 54 68 65 0d | 0a 73 69 6e 67 6c 65 20 |s. The.|.single |
|00002f20| 31 37 2d 48 50 20 6c 65 | 76 65 6c 20 33 30 20 6d |17-HP le|vel 30 m|
|00002f30| 69 6e 75 74 65 73 20 70 | 6f 73 74 20 41 43 54 48 |inutes p|ost ACTH|
|00002f40| 20 74 72 65 61 74 6d 65 | 6e 74 20 77 61 73 20 74 | treatme|nt was t|
|00002f50| 68 65 20 73 69 6d 70 6c | 65 73 74 20 61 6e 64 20 |he simpl|est and |
|00002f60| 6d 6f 73 74 0d 0a 63 6f | 73 74 20 65 66 66 65 63 |most..co|st effec|
|00002f70| 74 69 76 65 2e 20 20 54 | 68 65 20 39 20 61 64 64 |tive. T|he 9 add|
|00002f80| 69 74 69 6f 6e 61 6c 20 | 68 79 70 65 72 61 6e 64 |itional |hyperand|
|00002f90| 72 6f 67 65 6e 69 63 20 | 77 6f 6d 65 6e 20 77 68 |rogenic |women wh|
|00002fa0| 6f 20 68 61 64 20 61 74 | 20 6c 65 61 73 74 20 31 |o had at| least 1|
|00002fb0| 0d 0a 61 62 6e 6f 72 6d | 61 6c 20 32 31 2d 68 79 |..abnorm|al 21-hy|
|00002fc0| 64 72 6f 78 79 6c 61 73 | 65 20 6c 65 76 65 6c 20 |droxylas|e level |
|00002fd0| 6c 65 73 73 20 74 68 61 | 6e 20 33 20 74 69 6d 65 |less tha|n 3 time|
|00002fe0| 73 20 74 68 65 20 75 70 | 70 65 72 20 6e 6f 72 6d |s the up|per norm|
|00002ff0| 61 6c 20 39 35 74 68 0d | 0a 70 65 72 63 65 6e 74 |al 95th.|.percent|
|00003000| 69 6c 65 20 76 61 6c 75 | 65 20 77 65 72 65 20 63 |ile valu|e were c|
|00003010| 6c 61 73 73 69 66 69 65 | 64 20 61 73 20 68 61 76 |lassifie|d as hav|
|00003020| 69 6e 67 20 6d 69 6c 64 | 20 32 31 2d 68 79 64 72 |ing mild| 21-hydr|
|00003030| 6f 78 79 6c 61 73 65 20 | 64 65 66 69 63 69 65 6e |oxylase |deficien|
|00003040| 63 79 2e 0d 0a 42 61 73 | 61 6c 20 68 6f 72 6d 6f |cy...Bas|al hormo|
|00003050| 6e 61 6c 20 76 61 6c 75 | 65 73 20 64 69 64 20 6e |nal valu|es did n|
|00003060| 6f 74 20 64 69 73 74 69 | 6e 67 75 69 73 68 20 4c |ot disti|nguish L|
|00003070| 4f 41 48 20 70 61 74 69 | 65 6e 74 73 20 66 72 6f |OAH pati|ents fro|
|00003080| 6d 20 6f 74 68 65 72 20 | 70 61 74 69 65 6e 74 73 |m other |patients|
|00003090| 2c 0d 0a 61 6c 74 68 6f | 75 67 68 20 74 68 65 69 |,..altho|ugh thei|
|000030a0| 72 20 6d 65 61 6e 20 62 | 61 73 61 6c 20 61 6e 64 |r mean b|asal and|
|000030b0| 6f 73 74 65 6e 65 64 69 | 6f 6e 65 20 61 6e 64 20 |ostenedi|one and |
|000030c0| 31 37 2d 48 50 20 6c 65 | 76 65 6c 73 20 77 65 72 |17-HP le|vels wer|
|000030d0| 65 20 73 69 67 6e 69 66 | 69 63 61 6e 74 6c 79 0d |e signif|icantly.|
|000030e0| 0a 67 72 65 61 74 65 72 | 2e 20 20 41 20 62 61 73 |.greater|. A bas|
|000030f0| 61 6c 20 31 37 2d 48 50 | 20 6c 65 76 65 6c 20 6f |al 17-HP| level o|
|00003100| 66 20 6d 6f 72 65 20 74 | 68 61 6e 20 36 20 6e 6d |f more t|han 6 nm|
|00003110| 6f 6c 2f 4c 20 68 61 64 | 20 61 20 70 6f 73 69 74 |ol/L had| a posit|
|00003120| 69 76 65 20 70 72 65 64 | 69 63 74 69 76 65 0d 0a |ive pred|ictive..|
|00003130| 76 61 6c 75 65 20 66 6f | 72 20 61 20 73 74 69 6d |value fo|r a stim|
|00003140| 75 6c 61 74 65 64 20 31 | 37 2d 48 50 33 30 20 6c |ulated 1|7-HP30 l|
|00003150| 65 76 65 6c 20 61 62 6f | 76 65 20 33 36 2e 33 20 |evel abo|ve 36.3 |
|00003160| 6e 6d 6f 6c 2f 4c 2c 20 | 63 6f 6e 73 69 73 74 65 |nmol/L, |consiste|
|00003170| 6e 74 20 77 69 74 68 20 | 4c 4f 41 48 2c 0d 0a 6f |nt with |LOAH,..o|
|00003180| 66 20 38 30 25 2e 20 20 | 54 68 65 20 6e 65 67 61 |f 80%. |The nega|
|00003190| 74 69 76 65 20 70 72 65 | 64 69 63 74 69 76 65 20 |tive pre|dictive |
|000031a0| 76 61 6c 75 65 20 6f 66 | 20 61 20 62 61 73 61 6c |value of| a basal|
|000031b0| 20 31 37 2d 48 50 20 6c | 65 76 65 6c 20 6f 66 20 | 17-HP l|evel of |
|000031c0| 6c 65 73 73 20 74 68 61 | 6e 20 36 0d 0a 6e 6d 6f |less tha|n 6..nmo|
|000031d0| 6c 2f 4c 20 77 61 73 20 | 31 30 30 25 2e 0d 0a 20 |l/L was |100%... |
|000031e0| 20 20 20 20 54 68 65 20 | 68 69 67 68 20 70 72 65 | The |high pre|
|000031f0| 64 69 63 74 69 76 65 20 | 76 61 6c 75 65 20 6f 66 |dictive |value of|
|00003200| 20 73 63 72 65 65 6e 69 | 6e 67 20 66 6f 72 20 32 | screeni|ng for 2|
|00003210| 31 2d 68 79 64 72 6f 78 | 79 6c 61 73 65 2d 64 65 |1-hydrox|ylase-de|
|00003220| 66 69 63 69 65 6e 74 20 | 4c 4f 41 48 0d 0a 69 6e |ficient |LOAH..in|
|00003230| 20 68 79 70 65 72 61 6e | 64 72 6f 67 65 6e 69 63 | hyperan|drogenic|
|00003240| 20 77 6f 6d 65 6e 20 77 | 69 74 68 20 61 20 66 6f | women w|ith a fo|
|00003250| 6c 6c 69 63 75 6c 61 72 | 20 75 6e 73 75 70 70 72 |llicular| unsuppr|
|00003260| 65 73 73 65 64 20 6d 6f | 72 6e 69 6e 67 20 31 37 |essed mo|rning 17|
|00003270| 2d 48 50 20 6c 65 76 65 | 6c 0d 0a 77 61 73 20 63 |-HP leve|l..was c|
|00003280| 6f 6e 66 69 72 6d 65 64 | 2e 20 20 49 66 20 74 68 |onfirmed|. If th|
|00003290| 65 20 62 61 73 61 6c 20 | 31 37 2d 48 50 20 6c 65 |e basal |17-HP le|
|000032a0| 76 65 6c 20 69 73 20 68 | 69 67 68 65 72 20 74 68 |vel is h|igher th|
|000032b0| 61 6e 20 36 20 6e 6d 6f | 6c 2f 4c 2c 20 61 64 72 |an 6 nmo|l/L, adr|
|000032c0| 65 6e 61 6c 0d 0a 73 74 | 69 6d 75 6c 61 74 69 6f |enal..st|imulatio|
|000032d0| 6e 20 74 65 73 74 69 6e | 67 20 73 68 6f 75 6c 64 |n testin|g should|
|000032e0| 20 62 65 20 64 6f 6e 65 | 20 74 6f 20 72 75 6c 65 | be done| to rule|
|000032f0| 20 6f 75 74 20 4c 4f 41 | 48 2c 20 77 69 74 68 20 | out LOA|H, with |
|00003300| 61 20 31 37 2d 48 50 20 | 6c 65 76 65 6c 20 33 30 |a 17-HP |level 30|
|00003310| 0d 0a 6d 69 6e 75 74 65 | 73 20 70 6f 73 74 2d 41 |..minute|s post-A|
|00003320| 43 54 48 2d 28 31 2d 32 | 34 29 20 61 64 6d 69 6e |CTH-(1-2|4) admin|
|00003330| 69 73 74 72 61 74 69 6f | 6e 20 61 62 6f 76 65 20 |istratio|n above |
|00003340| 33 36 2e 33 20 6e 6d 6f | 6c 2f 4c 20 63 6f 6e 73 |36.3 nmo|l/L cons|
|00003350| 69 73 74 65 6e 74 20 77 | 69 74 68 20 74 68 65 0d |istent w|ith the.|
|00003360| 0a 64 69 61 67 6e 6f 73 | 69 73 2e 0d 0a 0d 0a 50 |.diagnos|is.....P|
|00003370| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00003380| 20 20 20 20 49 74 20 69 | 73 20 6e 6f 77 20 72 65 | It i|s now re|
|00003390| 63 6f 67 6e 69 7a 65 64 | 20 74 68 61 74 20 4c 4f |cognized| that LO|
|000033a0| 41 48 20 69 73 20 6e 6f | 74 20 61 6e 20 75 6e 63 |AH is no|t an unc|
|000033b0| 6f 6d 6d 6f 6e 20 6f 63 | 63 75 72 72 65 6e 63 65 |ommon oc|currence|
|000033c0| 20 61 6d 6f 6e 67 20 77 | 6f 6d 65 6e 0d 0a 77 69 | among w|omen..wi|
|000033d0| 74 68 20 73 69 67 6e 73 | 20 6f 66 20 68 79 70 65 |th signs| of hype|
|000033e0| 72 61 6e 64 72 6f 67 65 | 6e 69 73 6d 2e 20 20 42 |randroge|nism. B|
|000033f0| 65 63 61 75 73 65 20 74 | 68 69 73 20 64 69 73 6f |ecause t|his diso|
|00003400| 72 64 65 72 20 69 73 20 | 67 65 6e 65 74 69 63 61 |rder is |genetica|
|00003410| 6c 6c 79 0d 0a 74 72 61 | 6e 73 6d 69 74 74 65 64 |lly..tra|nsmitted|
|00003420| 2c 20 74 68 65 20 65 78 | 61 63 74 20 69 6e 63 69 |, the ex|act inci|
|00003430| 64 65 6e 63 65 20 69 6e | 20 61 6e 79 20 70 6f 70 |dence in| any pop|
|00003440| 75 6c 61 74 69 6f 6e 20 | 6f 66 20 70 61 74 69 65 |ulation |of patie|
|00003450| 6e 74 73 20 77 69 6c 6c | 20 76 61 72 79 0d 0a 61 |nts will| vary..a|
|00003460| 63 63 6f 72 64 69 6e 67 | 20 74 6f 20 74 68 65 20 |ccording| to the |
|00003470| 65 74 68 6e 69 63 20 63 | 68 61 72 61 63 74 65 72 |ethnic c|haracter|
|00003480| 69 73 74 69 63 73 20 6f | 66 20 74 68 65 20 70 6f |istics o|f the po|
|00003490| 70 75 6c 61 74 69 6f 6e | 2e 20 20 54 68 65 20 6f |pulation|. The o|
|000034a0| 70 74 69 6d 61 6c 0d 0a | 74 72 65 61 74 6d 65 6e |ptimal..|treatmen|
|000034b0| 74 20 6f 66 20 4c 4f 41 | 48 20 69 73 20 63 6f 72 |t of LOA|H is cor|
|000034c0| 74 69 63 6f 73 74 65 72 | 6f 69 64 73 20 69 6e 73 |ticoster|oids ins|
|000034d0| 74 65 61 64 20 6f 66 20 | 74 68 65 20 75 73 75 61 |tead of |the usua|
|000034e0| 6c 20 74 68 65 72 61 70 | 69 65 73 20 66 6f 72 0d |l therap|ies for.|
|000034f0| 0a 68 69 72 73 75 69 74 | 69 73 6d 2c 20 74 68 75 |.hirsuit|ism, thu|
|00003500| 73 20 69 74 20 69 73 20 | 62 65 6e 65 66 69 63 69 |s it is |benefici|
|00003510| 61 6c 20 74 6f 20 65 73 | 74 61 62 6c 69 73 68 20 |al to es|tablish |
|00003520| 74 68 65 20 64 69 61 67 | 6e 6f 73 69 73 20 69 66 |the diag|nosis if|
|00003530| 20 4c 4f 41 48 20 69 73 | 0d 0a 70 72 65 73 65 6e | LOAH is|..presen|
|00003540| 74 2e 20 20 4d 65 61 73 | 75 72 65 6d 65 6e 74 20 |t. Meas|urement |
|00003550| 6f 66 20 61 6e 20 65 6c | 65 76 61 74 65 64 20 66 |of an el|evated f|
|00003560| 6f 6c 6c 69 63 75 6c 61 | 72 20 70 68 61 73 65 20 |ollicula|r phase |
|00003570| 31 37 2d 48 50 20 6c 65 | 76 65 6c 20 77 69 6c 6c |17-HP le|vel will|
|00003580| 0d 0a 69 6e 64 69 63 61 | 74 65 20 77 68 69 63 68 |..indica|te which|
|00003590| 20 70 61 74 69 65 6e 74 | 73 20 73 68 6f 75 6c 64 | patient|s should|
|000035a0| 20 68 61 76 65 20 74 68 | 65 20 64 69 61 67 6e 6f | have th|e diagno|
|000035b0| 73 74 69 63 20 41 43 54 | 48 20 73 74 69 6d 75 6c |stic ACT|H stimul|
|000035c0| 61 74 69 6f 6e 20 74 65 | 73 74 2c 20 61 73 0d 0a |ation te|st, as..|
|000035d0| 64 65 73 63 72 69 62 65 | 64 20 69 6e 20 74 68 65 |describe|d in the|
|000035e0| 20 61 62 73 74 72 61 63 | 74 2c 20 70 65 72 66 6f | abstrac|t, perfo|
|000035f0| 72 6d 65 64 2e 2d 2d 44 | 2e 52 2e 20 4d 69 73 68 |rmed.--D|.R. Mish|
|00003600| 65 6c 6c 2c 20 4a 72 2e | 2c 20 4d 2e 44 2e 0d 0a |ell, Jr.|, M.D...|
|00003610| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 32 |$Unique_|ID{YRB02|
|00003620| 37 30 33 7d 0d 0a 24 54 | 69 74 6c 65 7b 4c 61 74 |703}..$T|itle{Lat|
|00003630| 65 20 4f 6e 73 65 74 20 | 41 64 72 65 6e 61 6c 20 |e Onset |Adrenal |
|00003640| 48 79 70 65 72 70 6c 61 | 73 69 61 20 69 6e 20 61 |Hyperpla|sia in a|
|00003650| 20 47 72 6f 75 70 20 6f | 66 20 49 72 69 73 68 20 | Group o|f Irish |
|00003660| 46 65 6d 61 6c 65 73 20 | 57 68 6f 0d 0a 50 72 65 |Females |Who..Pre|
|00003670| 73 65 6e 74 65 64 20 57 | 69 74 68 20 48 69 72 73 |sented W|ith Hirs|
|00003680| 75 74 69 73 6d 2c 20 49 | 72 72 65 67 75 6c 61 72 |utism, I|rregular|
|00003690| 20 4d 65 6e 73 65 73 20 | 61 6e 64 2f 6f 72 20 43 | Menses |and/or C|
|000036a0| 79 73 74 69 63 20 41 63 | 6e 65 7d 0d 0a 24 41 75 |ystic Ac|ne}..$Au|
|000036b0| 74 68 6f 72 7b 0d 0a 4d | 63 4c 61 75 67 68 6c 69 |thor{..M|cLaughli|
|000036c0| 6e 2c 20 42 0d 0a 42 61 | 72 72 65 74 74 2c 20 50 |n, B..Ba|rrett, P|
|000036d0| 0d 0a 46 69 6e 63 68 2c | 20 54 0d 0a 44 65 76 6c |..Finch,| T..Devl|
|000036e0| 69 6e 2c 20 4a 47 7d 0d | 0a 24 41 66 66 69 6c 69 |in, JG}.|.$Affili|
|000036f0| 61 74 69 6f 6e 7b 42 65 | 61 75 6d 6f 6e 74 20 48 |ation{Be|aumont H|
|00003700| 6f 73 70 2c 20 44 75 62 | 6c 69 6e 3b 20 49 72 69 |osp, Dub|lin; Iri|
|00003710| 73 68 20 42 6c 6f 6f 64 | 20 54 72 61 6e 73 66 75 |sh Blood| Transfu|
|00003720| 73 69 6f 6e 20 42 6f 61 | 72 64 2c 20 44 75 62 6c |sion Boa|rd, Dubl|
|00003730| 69 6e 7d 0d 0a 24 4a 6f | 75 72 6e 61 6c 7b 43 6c |in}..$Jo|urnal{Cl|
|00003740| 69 6e 20 45 6e 64 6f 63 | 72 69 6e 6f 6c 7d 0d 0a |in Endoc|rinol}..|
|00003750| 24 56 6f 6c 75 6d 65 7b | 33 32 7d 0d 0a 24 50 61 |$Volume{|32}..$Pa|
|00003760| 67 65 7b 35 37 2d 36 34 | 7d 0d 0a 24 44 61 74 65 |ge{57-64|}..$Date|
|00003770| 7b 31 39 39 30 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 |{1990}..|$YBVol{1|
|00003780| 39 39 31 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |991 Year| Book of|
|00003790| 20 4f 62 73 74 65 74 72 | 69 63 73 20 61 6e 64 20 | Obstetr|ics and |
|000037a0| 47 79 6e 65 63 6f 6c 6f | 67 79 7d 0d 0a 24 43 68 |Gynecolo|gy}..$Ch|
|000037b0| 61 70 74 65 72 7b 31 35 | 2d 31 33 7d 0d 0a 24 59 |apter{15|-13}..$Y|
|000037c0| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 4d 69 73 |BEditor{|Drs. Mis|
|000037d0| 68 65 6c 6c 2c 20 4b 69 | 72 73 63 68 62 61 75 6d |hell, Ki|rschbaum|
|000037e0| 2c 20 61 6e 64 20 4d 6f | 72 72 6f 77 7d 0d 0a 24 |, and Mo|rrow}..$|
|000037f0| 54 61 62 6c 65 7b 7d 0d | 0a 24 43 6f 6d 6d 65 6e |Table{}.|.$Commen|
|00003800| 74 61 74 6f 72 7b 44 2e | 52 2e 20 4d 69 73 68 65 |tator{D.|R. Mishe|
|00003810| 6c 6c 2c 20 4a 72 2e 2c | 20 4d 2e 44 2e 7d 0d 0a |ll, Jr.,| M.D.}..|
|00003820| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 43 29 20 |..Copyri|ght (C) |
|00003830| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|00003840| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|00003850| 63 2e 20 31 39 39 31 0d | 0a 0d 0a 31 39 39 31 20 |c. 1991.|...1991 |
|00003860| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4f 62 73 |Year Boo|k of Obs|
|00003870| 74 65 74 72 69 63 73 20 | 61 6e 64 20 47 79 6e 65 |tetrics |and Gyne|
|00003880| 63 6f 6c 6f 67 79 0d 0a | 0d 0a 47 79 6e 65 63 6f |cology..|..Gyneco|
|00003890| 6c 6f 67 79 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 |logy....|Chapter |
|000038a0| 31 35 20 2d 2d 20 45 6e | 64 6f 63 72 69 6e 6f 6c |15 -- En|docrinol|
|000038b0| 6f 67 79 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ogy....-|--------|
|000038c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003900| 2d 2d 2d 2d 2d 0d 0a 4c | 61 74 65 20 4f 6e 73 65 |-----..L|ate Onse|
|00003910| 74 20 41 64 72 65 6e 61 | 6c 20 48 79 70 65 72 70 |t Adrena|l Hyperp|
|00003920| 6c 61 73 69 61 20 69 6e | 20 61 20 47 72 6f 75 70 |lasia in| a Group|
|00003930| 20 6f 66 20 49 72 69 73 | 68 20 46 65 6d 61 6c 65 | of Iris|h Female|
|00003940| 73 20 57 68 6f 20 50 72 | 65 73 65 6e 74 65 64 20 |s Who Pr|esented |
|00003950| 57 69 74 68 0d 0a 48 69 | 72 73 75 74 69 73 6d 2c |With..Hi|rsutism,|
|00003960| 20 49 72 72 65 67 75 6c | 61 72 20 4d 65 6e 73 65 | Irregul|ar Mense|
|00003970| 73 20 61 6e 64 2f 6f 72 | 20 43 79 73 74 69 63 20 |s and/or| Cystic |
|00003980| 41 63 6e 65 0d 0a 0d 0a | 4d 63 4c 61 75 67 68 6c |Acne....|McLaughl|
|00003990| 69 6e 20 42 3b 20 42 61 | 72 72 65 74 74 20 50 3b |in B; Ba|rrett P;|
|000039a0| 20 46 69 6e 63 68 20 54 | 3b 20 44 65 76 6c 69 6e | Finch T|; Devlin|
|000039b0| 20 4a 47 0d 0a 28 42 65 | 61 75 6d 6f 6e 74 20 48 | JG..(Be|aumont H|
|000039c0| 6f 73 70 2c 20 44 75 62 | 6c 69 6e 3b 20 49 72 69 |osp, Dub|lin; Iri|
|000039d0| 73 68 20 42 6c 6f 6f 64 | 20 54 72 61 6e 73 66 75 |sh Blood| Transfu|
|000039e0| 73 69 6f 6e 20 42 6f 61 | 72 64 2c 20 44 75 62 6c |sion Boa|rd, Dubl|
|000039f0| 69 6e 29 0d 0a 43 6c 69 | 6e 20 45 6e 64 6f 63 72 |in)..Cli|n Endocr|
|00003a00| 69 6e 6f 6c 20 33 32 3a | 35 37 2d 36 34 2c 20 31 |inol 32:|57-64, 1|
|00003a10| 39 39 30 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |990..---|--------|
|00003a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a60| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00003a70| 0a 0d 0a 20 20 20 20 20 | 4c 61 74 65 2d 6f 6e 73 |... |Late-ons|
|00003a80| 65 74 20 61 64 72 65 6e | 61 6c 20 68 79 70 65 72 |et adren|al hyper|
|00003a90| 70 6c 61 73 69 61 20 63 | 61 6e 20 69 6e 76 6f 6c |plasia c|an invol|
|00003aa0| 76 65 20 64 65 66 69 63 | 69 65 6e 63 69 65 73 20 |ve defic|iencies |
|00003ab0| 69 6e 20 61 6c 6c 20 35 | 20 65 6e 7a 79 6d 65 73 |in all 5| enzymes|
|00003ac0| 0d 0a 72 65 71 75 69 72 | 65 64 20 66 6f 72 20 63 |..requir|ed for c|
|00003ad0| 6f 72 74 69 73 6f 6c 20 | 62 69 6f 73 79 6e 74 68 |ortisol |biosynth|
|00003ae0| 65 73 69 73 2e 20 20 54 | 68 65 20 66 72 65 71 75 |esis. T|he frequ|
|00003af0| 65 6e 63 79 20 6f 66 20 | 6c 61 74 65 2d 6f 6e 73 |ency of |late-ons|
|00003b00| 65 74 20 61 64 72 65 6e | 61 6c 0d 0a 68 79 70 65 |et adren|al..hype|
|00003b10| 72 70 6c 61 73 69 61 20 | 63 61 75 73 65 64 20 62 |rplasia |caused b|
|00003b20| 79 20 32 31 2d 68 79 64 | 72 6f 78 79 6c 61 73 65 |y 21-hyd|roxylase|
|00003b30| 20 64 65 66 69 63 69 65 | 6e 63 79 20 77 61 73 20 | deficie|ncy was |
|00003b40| 65 73 74 69 6d 61 74 65 | 64 20 69 6e 20 31 31 39 |estimate|d in 119|
|00003b50| 20 49 72 69 73 68 0d 0a | 77 6f 6d 65 6e 20 77 68 | Irish..|women wh|
|00003b60| 6f 20 68 61 64 20 73 79 | 6d 70 74 6f 6d 73 20 6f |o had sy|mptoms o|
|00003b70| 66 20 68 79 70 65 72 61 | 6e 64 72 6f 67 65 6e 69 |f hypera|ndrogeni|
|00003b80| 73 6d 20 77 69 74 68 6f | 75 74 20 6f 62 76 69 6f |sm witho|ut obvio|
|00003b90| 75 73 20 75 6e 64 65 72 | 6c 79 69 6e 67 20 63 61 |us under|lying ca|
|00003ba0| 75 73 65 3b 0d 0a 61 6c | 73 6f 2c 20 77 68 65 74 |use;..al|so, whet|
|00003bb0| 68 65 72 20 61 6e 79 20 | 70 61 72 74 69 63 75 6c |her any |particul|
|00003bc0| 61 72 20 48 4c 41 20 68 | 61 70 6c 6f 74 79 70 65 |ar HLA h|aplotype|
|00003bd0| 20 61 73 73 6f 63 69 61 | 74 69 6f 6e 20 69 73 20 | associa|tion is |
|00003be0| 70 72 65 73 65 6e 74 20 | 69 6e 20 70 61 74 69 65 |present |in patie|
|00003bf0| 6e 74 73 0d 0a 77 69 74 | 68 20 70 61 72 74 69 61 |nts..wit|h partia|
|00003c00| 6c 20 32 31 2d 68 79 64 | 72 6f 78 79 6c 61 73 65 |l 21-hyd|roxylase|
|00003c10| 20 64 65 66 69 63 69 65 | 6e 63 79 20 77 61 73 20 | deficie|ncy was |
|00003c20| 69 6e 76 65 73 74 69 67 | 61 74 65 64 2e 0d 0a 20 |investig|ated... |
|00003c30| 20 20 20 20 42 6c 6f 6f | 64 20 73 61 6d 70 6c 65 | Bloo|d sample|
|00003c40| 73 20 77 65 72 65 20 74 | 61 6b 65 6e 20 61 74 20 |s were t|aken at |
|00003c50| 62 61 73 65 6c 69 6e 65 | 20 61 6e 64 20 31 20 68 |baseline| and 1 h|
|00003c60| 6f 75 72 20 61 66 74 65 | 72 20 69 6e 6a 65 63 74 |our afte|r inject|
|00003c70| 69 6f 6e 20 6f 66 20 2e | 32 35 20 6d 67 0d 0a 6f |ion of .|25 mg..o|
|00003c80| 66 20 73 79 6e 61 63 74 | 68 65 6e 2e 20 20 54 68 |f synact|hen. Th|
|00003c90| 65 20 68 6f 72 6d 6f 6e | 65 73 20 70 72 6f 66 69 |e hormon|es profi|
|00003ca0| 6c 65 64 20 69 6e 63 6c | 75 64 65 64 20 31 37 2d |led incl|uded 17-|
|00003cb0| 68 79 64 72 6f 78 79 20 | 28 4f 48 29 20 70 72 6f |hydroxy |(OH) pro|
|00003cc0| 67 65 73 74 65 72 6f 6e | 65 2c 0d 0a 31 31 2d 64 |gesteron|e,..11-d|
|00003cd0| 65 6f 78 79 63 6f 72 74 | 69 73 6f 6c 2c 20 61 6e |eoxycort|isol, an|
|00003ce0| 64 72 6f 73 74 65 6e 65 | 64 69 6f 6e 65 2c 20 74 |drostene|dione, t|
|00003cf0| 65 73 74 6f 73 74 65 72 | 6f 6e 65 2c 20 64 65 68 |estoster|one, deh|
|00003d00| 79 64 72 6f 65 70 69 61 | 6e 64 72 6f 73 74 65 72 |ydroepia|ndroster|
|00003d10| 6f 6e 65 2c 20 61 6e 64 | 0d 0a 63 6f 72 74 69 73 |one, and|..cortis|
|00003d20| 6f 6c 2e 20 20 4e 69 6e | 65 74 79 2d 73 69 78 20 |ol. Nin|ety-six |
|00003d30| 77 6f 6d 65 6e 20 77 65 | 72 65 20 72 65 66 65 72 |women we|re refer|
|00003d40| 72 65 64 20 66 6f 72 20 | 69 6e 76 65 73 74 69 67 |red for |investig|
|00003d50| 61 74 69 6f 6e 20 6f 66 | 0d 0a 68 79 70 65 72 61 |ation of|..hypera|
|00003d60| 6e 64 72 6f 67 65 6e 69 | 73 6d 2c 20 61 6e 64 20 |ndrogeni|sm, and |
|00003d70| 32 33 20 77 6f 6d 65 6e | 20 73 65 72 76 65 64 20 |23 women| served |
|00003d80| 61 73 20 63 6f 6e 74 72 | 6f 6c 73 2e 20 20 53 69 |as contr|ols. Si|
|00003d90| 78 20 70 61 74 69 65 6e | 74 73 20 68 61 64 20 65 |x patien|ts had e|
|00003da0| 76 69 64 65 6e 63 65 0d | 0a 6f 66 20 70 61 72 74 |vidence.|.of part|
|00003db0| 69 61 6c 20 32 31 2d 68 | 79 64 72 6f 78 79 6c 61 |ial 21-h|ydroxyla|
|00003dc0| 73 65 20 64 65 66 69 63 | 69 65 6e 63 79 2c 20 33 |se defic|iency, 3|
|00003dd0| 20 6f 66 20 77 68 6f 6d | 20 68 61 64 20 6e 6f 72 | of whom| had nor|
|00003de0| 6d 61 6c 20 62 61 73 65 | 6c 69 6e 65 20 6c 65 76 |mal base|line lev|
|00003df0| 65 6c 73 20 6f 66 0d 0a | 31 37 2d 4f 48 20 70 72 |els of..|17-OH pr|
|00003e00| 6f 67 65 73 74 65 72 6f | 6e 65 3b 20 74 68 65 20 |ogestero|ne; the |
|00003e10| 62 69 6f 63 68 65 6d 69 | 63 61 6c 20 61 62 6e 6f |biochemi|cal abno|
|00003e20| 72 6d 61 6c 69 74 79 20 | 77 61 73 20 6d 61 6e 69 |rmality |was mani|
|00003e30| 66 65 73 74 20 6f 6e 6c | 79 20 77 69 74 68 0d 0a |fest onl|y with..|
|00003e40| 73 79 6e 61 63 74 68 65 | 6e 20 73 74 69 6d 75 6c |synacthe|n stimul|
|00003e50| 61 74 69 6f 6e 2e 0d 0a | 20 20 20 20 20 54 68 65 |ation...| The|
|00003e60| 20 64 69 61 67 6e 6f 73 | 69 73 20 6f 66 20 6c 61 | diagnos|is of la|
|00003e70| 74 65 2d 6f 6e 73 65 74 | 20 61 64 72 65 6e 61 6c |te-onset| adrenal|
|00003e80| 20 68 79 70 65 72 70 6c | 61 73 69 61 20 63 61 75 | hyperpl|asia cau|
|00003e90| 73 65 64 20 62 79 20 70 | 61 72 74 69 61 6c 0d 0a |sed by p|artial..|
|00003ea0| 64 65 66 69 63 69 65 6e | 63 79 20 6f 66 20 32 31 |deficien|cy of 21|
|00003eb0| 2d 68 79 64 72 6f 78 79 | 6c 61 73 65 20 73 68 6f |-hydroxy|lase sho|
|00003ec0| 75 6c 64 20 61 6c 77 61 | 79 73 20 62 65 20 63 6f |uld alwa|ys be co|
|00003ed0| 6e 73 69 64 65 72 65 64 | 20 69 6e 20 70 61 74 69 |nsidered| in pati|
|00003ee0| 65 6e 74 73 20 77 68 6f | 20 68 61 76 65 0d 0a 73 |ents who| have..s|
|00003ef0| 79 6d 70 74 6f 6d 73 20 | 6f 66 20 68 79 70 65 72 |ymptoms |of hyper|
|00003f00| 61 6e 64 72 6f 67 65 6e | 69 73 6d 2e 20 20 53 79 |androgen|ism. Sy|
|00003f10| 6e 61 63 68 65 6e 20 73 | 74 69 6d 75 6c 61 74 69 |nachen s|timulati|
|00003f20| 6f 6e 20 69 73 20 61 20 | 76 61 6c 75 61 62 6c 65 |on is a |valuable|
|00003f30| 20 64 69 61 67 6e 6f 73 | 74 69 63 0d 0a 74 6f 6f | diagnos|tic..too|
|00003f40| 6c 20 66 6f 72 20 65 6c | 75 63 69 64 61 74 69 6e |l for el|ucidatin|
|00003f50| 67 20 70 61 72 74 69 61 | 6c 20 65 6e 7a 79 6d 65 |g partia|l enzyme|
|00003f60| 20 64 65 66 69 63 69 65 | 6e 63 79 2e 0d 0a 0d 0a | deficie|ncy.....|
|00003f70| 50 6f 73 74 2d 43 6f 6d | 6d 65 6e 74 0d 0a 0d 0a |Post-Com|ment....|
|00003f80| 20 20 20 20 20 44 65 70 | 65 6e 64 69 6e 67 20 6f | Dep|ending o|
|00003f90| 6e 20 74 68 65 20 70 6f | 70 75 6c 61 74 69 6f 6e |n the po|pulation|
|00003fa0| 20 62 65 69 6e 67 20 73 | 74 75 64 69 65 64 2c 20 | being s|tudied, |
|00003fb0| 61 62 6f 75 74 20 31 30 | 25 20 6f 66 20 77 6f 6d |about 10|% of wom|
|00003fc0| 65 6e 20 77 69 74 68 0d | 0a 70 68 79 73 69 63 61 |en with.|.physica|
|00003fd0| 6c 20 73 69 67 6e 73 20 | 6f 66 20 68 79 70 65 72 |l signs |of hyper|
|00003fe0| 61 6e 64 72 6f 67 65 6e | 69 73 6d 20 77 69 6c 6c |androgen|ism will|
|00003ff0| 20 68 61 76 65 20 73 6f | 6d 65 20 64 65 67 72 65 | have so|me degre|
|00004000| 65 20 6f 66 20 32 31 2d | 68 79 64 72 6f 78 79 6c |e of 21-|hydroxyl|
|00004010| 61 73 65 0d 0a 64 65 66 | 69 63 69 65 6e 63 79 2c |ase..def|iciency,|
|00004020| 20 63 6f 6e 73 69 73 74 | 65 6e 74 20 77 69 74 68 | consist|ent with|
|00004030| 20 74 68 65 20 64 69 61 | 67 6e 6f 73 69 73 20 6f | the dia|gnosis o|
|00004040| 66 20 61 64 75 6c 74 20 | 6f 6e 73 65 74 20 6f 66 |f adult |onset of|
|00004050| 20 61 64 72 65 6e 61 6c | 0d 0a 68 79 70 65 72 70 | adrenal|..hyperp|
|00004060| 6c 61 73 69 61 2e 20 20 | 4e 6f 74 20 61 6c 6c 20 |lasia. |Not all |
|00004070| 73 75 63 68 20 70 61 74 | 69 65 6e 74 73 20 77 69 |such pat|ients wi|
|00004080| 6c 6c 20 62 65 20 64 65 | 74 65 63 74 65 64 20 62 |ll be de|tected b|
|00004090| 79 20 66 69 6e 64 69 6e | 67 20 61 6e 20 65 6c 65 |y findin|g an ele|
|000040a0| 76 61 74 65 64 0d 0a 62 | 61 73 65 6c 69 6e 65 20 |vated..b|aseline |
|000040b0| 6c 65 76 65 6c 20 6f 66 | 20 64 65 68 79 70 72 6f |level of| dehypro|
|000040c0| 65 70 69 61 6e 64 72 6f | 73 74 65 72 6f 6e 65 20 |epiandro|sterone |
|000040d0| 6f 72 20 31 37 2d 4f 48 | 20 70 72 6f 67 65 73 74 |or 17-OH| progest|
|000040e0| 65 72 6f 6e 65 20 6c 65 | 76 65 6c 2e 20 20 49 74 |erone le|vel. It|
|000040f0| 20 69 73 0d 0a 6e 65 63 | 65 73 73 61 72 79 20 74 | is..nec|essary t|
|00004100| 6f 20 70 65 72 66 6f 72 | 6d 20 61 64 72 65 6e 61 |o perfor|m adrena|
|00004110| 6c 20 73 74 69 6d 75 6c | 61 74 69 6f 6e 20 77 69 |l stimul|ation wi|
|00004120| 74 68 20 41 43 54 48 20 | 61 6e 64 20 74 68 65 6e |th ACTH |and then|
|00004130| 20 6d 65 61 73 75 72 65 | 20 31 37 2d 4f 48 0d 0a | measure| 17-OH..|
|00004140| 70 72 6f 67 65 73 74 65 | 72 6f 6e 65 20 74 6f 20 |progeste|rone to |
|00004150| 64 65 74 65 72 6d 69 6e | 65 20 20 77 68 65 74 68 |determin|e wheth|
|00004160| 65 72 20 74 68 65 20 65 | 6e 7a 79 6d 61 74 69 63 |er the e|nzymatic|
|00004170| 20 64 65 66 69 63 69 65 | 6e 63 79 20 65 78 69 73 | deficie|ncy exis|
|00004180| 74 73 2e 20 20 4f 6e 63 | 65 20 74 68 65 0d 0a 64 |ts. Onc|e the..d|
|00004190| 69 61 67 6e 6f 73 69 73 | 20 69 73 20 6d 61 64 65 |iagnosis| is made|
|000041a0| 2c 20 74 68 65 20 61 70 | 70 72 6f 70 72 69 61 74 |, the ap|propriat|
|000041b0| 65 20 74 72 65 61 74 6d | 65 6e 74 20 69 73 20 77 |e treatm|ent is w|
|000041c0| 69 74 68 20 67 6c 75 63 | 6f 63 6f 72 74 69 63 6f |ith gluc|ocortico|
|000041d0| 69 64 73 2e 0d 0a 55 73 | 75 61 6c 6c 79 2c 0d 0a |ids...Us|ually,..|
|000041e0| 2e 32 35 20 74 6f 20 2e | 35 20 6d 67 20 6f 66 20 |.25 to .|5 mg of |
|000041f0| 64 65 78 6f 6d 65 74 68 | 61 73 6f 6e 65 20 6e 69 |dexometh|asone ni|
|00004200| 67 68 74 6c 79 20 69 73 | 20 73 75 66 66 69 63 69 |ghtly is| suffici|
|00004210| 65 6e 74 20 74 6f 20 74 | 72 65 61 74 20 74 68 65 |ent to t|reat the|
|00004220| 0d 0a 64 69 73 6f 72 64 | 65 72 2e 2d 2d 44 2e 52 |..disord|er.--D.R|
|00004230| 2e 20 4d 69 73 68 65 6c | 6c 2c 20 4a 72 2e 2c 20 |. Mishel|l, Jr., |
|00004240| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00004250| 7b 59 52 42 30 32 37 30 | 34 7d 0d 0a 24 54 69 74 |{YRB0270|4}..$Tit|
|00004260| 6c 65 7b 35 20 61 6c 70 | 68 61 2d 52 65 64 75 63 |le{5 alp|ha-Reduc|
|00004270| 74 61 73 65 20 41 63 74 | 69 76 69 74 79 20 69 6e |tase Act|ivity in|
|00004280| 20 50 6f 6c 79 63 79 73 | 74 69 63 20 4f 76 61 72 | Polycys|tic Ovar|
|00004290| 79 20 53 79 6e 64 72 6f | 6d 65 7d 0d 0a 24 41 75 |y Syndro|me}..$Au|
|000042a0| 74 68 6f 72 7b 0d 0a 53 | 74 65 77 61 72 74 2c 20 |thor{..S|tewart, |
|000042b0| 50 4d 0d 0a 53 68 61 63 | 6b 6c 65 74 6f 6e 2c 20 |PM..Shac|kleton, |
|000042c0| 43 48 4c 0d 0a 42 65 61 | 73 74 61 6c 6c 2c 20 47 |CHL..Bea|stall, G|
|000042d0| 48 0d 0a 45 64 77 61 72 | 64 73 2c 20 43 52 57 7d |H..Edwar|ds, CRW}|
|000042e0| 0d 0a 24 41 66 66 69 6c | 69 61 74 69 6f 6e 7b 57 |..$Affil|iation{W|
|000042f0| 65 73 74 65 72 6e 20 47 | 65 6e 20 48 6f 73 70 2c |estern G|en Hosp,|
|00004300| 20 45 64 69 6e 62 75 72 | 67 68 3b 20 43 68 69 6c | Edinbur|gh; Chil|
|00004310| 64 72 65 6e 27 73 20 48 | 6f 73 70 20 4d 65 64 20 |dren's H|osp Med |
|00004320| 43 74 72 20 6f 66 20 4e | 6f 72 74 68 65 72 6e 0d |Ctr of N|orthern.|
|00004330| 0a 43 61 6c 69 66 6f 72 | 6e 69 61 2c 20 4f 61 6b |.Califor|nia, Oak|
|00004340| 6c 61 6e 64 3b 20 47 6c | 61 73 67 6f 77 20 52 6f |land; Gl|asgow Ro|
|00004350| 79 61 6c 20 49 6e 66 69 | 72 6d 61 72 79 7d 0d 0a |yal Infi|rmary}..|
|00004360| 24 4a 6f 75 72 6e 61 6c | 7b 4c 61 6e 63 65 74 7d |$Journal|{Lancet}|
|00004370| 0d 0a 24 56 6f 6c 75 6d | 65 7b 33 33 35 7d 0d 0a |..$Volum|e{335}..|
|00004380| 24 50 61 67 65 7b 34 33 | 31 2d 34 33 33 7d 0d 0a |$Page{43|1-433}..|
|00004390| 24 44 61 74 65 7b 31 39 | 39 30 7d 0d 0a 24 59 42 |$Date{19|90}..$YB|
|000043a0| 56 6f 6c 7b 31 39 39 31 | 20 59 65 61 72 20 42 6f |Vol{1991| Year Bo|
|000043b0| 6f 6b 20 6f 66 20 4f 62 | 73 74 65 74 72 69 63 73 |ok of Ob|stetrics|
|000043c0| 20 61 6e 64 20 47 79 6e | 65 63 6f 6c 6f 67 79 7d | and Gyn|ecology}|
|000043d0| 0d 0a 24 43 68 61 70 74 | 65 72 7b 31 35 2d 31 34 |..$Chapt|er{15-14|
|000043e0| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|000043f0| 2e 20 4d 69 73 68 65 6c | 6c 2c 20 4b 69 72 73 63 |. Mishel|l, Kirsc|
|00004400| 68 62 61 75 6d 2c 20 61 | 6e 64 20 4d 6f 72 72 6f |hbaum, a|nd Morro|
|00004410| 77 7d 0d 0a 24 54 61 62 | 6c 65 7b 7d 0d 0a 24 43 |w}..$Tab|le{}..$C|
|00004420| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 44 2e 52 2e 20 |ommentat|or{D.R. |
|00004430| 4d 69 73 68 65 6c 6c 2c | 20 4a 72 2e 2c 20 4d 2e |Mishell,| Jr., M.|
|00004440| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|00004450| 20 28 43 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (C) Yea|r Book M|
|00004460| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00004470| 73 2c 20 49 6e 63 2e 20 | 31 39 39 31 0d 0a 0d 0a |s, Inc. |1991....|
|00004480| 31 39 39 31 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1991 Yea|r Book o|
|00004490| 66 20 4f 62 73 74 65 74 | 72 69 63 73 20 61 6e 64 |f Obstet|rics and|
|000044a0| 20 47 79 6e 65 63 6f 6c | 6f 67 79 0d 0a 0d 0a 47 | Gynecol|ogy....G|
|000044b0| 79 6e 65 63 6f 6c 6f 67 | 79 0d 0a 0d 0a 43 68 61 |ynecolog|y....Cha|
|000044c0| 70 74 65 72 20 31 35 20 | 2d 2d 20 45 6e 64 6f 63 |pter 15 |-- Endoc|
|000044d0| 72 69 6e 6f 6c 6f 67 79 | 0d 0a 0d 0a 2d 2d 2d 2d |rinology|....----|
|000044e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004520| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 35 20 61 6c |--------|--..5 al|
|00004530| 70 68 61 2d 52 65 64 75 | 63 74 61 73 65 20 41 63 |pha-Redu|ctase Ac|
|00004540| 74 69 76 69 74 79 20 69 | 6e 20 50 6f 6c 79 63 79 |tivity i|n Polycy|
|00004550| 73 74 69 63 20 4f 76 61 | 72 79 20 53 79 6e 64 72 |stic Ova|ry Syndr|
|00004560| 6f 6d 65 0d 0a 0d 0a 53 | 74 65 77 61 72 74 20 50 |ome....S|tewart P|
|00004570| 4d 3b 20 53 68 61 63 6b | 6c 65 74 6f 6e 20 43 48 |M; Shack|leton CH|
|00004580| 4c 3b 20 42 65 61 73 74 | 61 6c 6c 20 47 48 3b 20 |L; Beast|all GH; |
|00004590| 45 64 77 61 72 64 73 20 | 43 52 57 0d 0a 28 57 65 |Edwards |CRW..(We|
|000045a0| 73 74 65 72 6e 20 47 65 | 6e 20 48 6f 73 70 2c 20 |stern Ge|n Hosp, |
|000045b0| 45 64 69 6e 62 75 72 67 | 68 3b 20 43 68 69 6c 64 |Edinburg|h; Child|
|000045c0| 72 65 6e 27 73 20 48 6f | 73 70 20 4d 65 64 20 43 |ren's Ho|sp Med C|
|000045d0| 74 72 20 6f 66 20 4e 6f | 72 74 68 65 72 6e 20 43 |tr of No|rthern C|
|000045e0| 61 6c 69 66 6f 72 6e 69 | 61 2c 0d 0a 4f 61 6b 6c |aliforni|a,..Oakl|
|000045f0| 61 6e 64 3b 20 47 6c 61 | 73 67 6f 77 20 52 6f 79 |and; Gla|sgow Roy|
|00004600| 61 6c 20 49 6e 66 69 72 | 6d 61 72 79 29 0d 0a 4c |al Infir|mary)..L|
|00004610| 61 6e 63 65 74 20 33 33 | 35 3a 34 33 31 2d 34 33 |ancet 33|5:431-43|
|00004620| 33 2c 20 31 39 39 30 0d | 0a 2d 2d 2d 2d 2d 2d 2d |3, 1990.|.-------|
|00004630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004640| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004650| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004660| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004670| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00004680| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 48 69 67 68 |act.... | High|
|00004690| 20 35 20 61 6c 70 68 61 | 2d 72 65 64 75 63 74 61 | 5 alpha|-reducta|
|000046a0| 73 65 20 61 63 74 69 76 | 69 74 79 20 69 6e 20 73 |se activ|ity in s|
|000046b0| 6b 69 6e 20 69 6e 20 70 | 61 74 69 65 6e 74 73 20 |kin in p|atients |
|000046c0| 77 69 74 68 20 70 6f 6c | 79 63 79 73 74 69 63 20 |with pol|ycystic |
|000046d0| 6f 76 61 72 79 0d 0a 73 | 79 6e 64 72 6f 6d 65 20 |ovary..s|yndrome |
|000046e0| 28 50 43 4f 53 29 20 63 | 6f 6e 76 65 72 74 73 20 |(PCOS) c|onverts |
|000046f0| 74 65 73 74 6f 73 74 65 | 72 6f 6e 65 20 74 6f 20 |testoste|rone to |
|00004700| 64 69 68 79 64 72 6f 74 | 65 73 74 6f 73 74 65 72 |dihydrot|estoster|
|00004710| 6f 6e 65 2c 20 72 65 73 | 75 6c 74 69 6e 67 20 69 |one, res|ulting i|
|00004720| 6e 0d 0a 68 69 72 73 75 | 74 69 73 6d 2e 20 20 49 |n..hirsu|tism. I|
|00004730| 74 20 69 73 20 70 6f 73 | 73 69 62 6c 65 20 69 6e |t is pos|sible in|
|00004740| 20 50 43 4f 53 20 74 68 | 61 74 20 69 6e 63 72 65 | PCOS th|at incre|
|00004750| 61 73 65 64 20 63 6f 72 | 74 69 73 6f 6c 20 6d 65 |ased cor|tisol me|
|00004760| 74 61 62 6f 6c 69 73 6d | 0d 0a 63 6f 6e 73 65 71 |tabolism|..conseq|
|00004770| 75 65 6e 74 20 74 6f 20 | 6f 76 65 72 61 63 74 69 |uent to |overacti|
|00004780| 76 69 74 79 20 6f 66 20 | 74 68 69 73 20 65 6e 7a |vity of |this enz|
|00004790| 79 6d 65 20 73 74 69 6d | 75 6c 61 74 65 73 20 61 |yme stim|ulates a|
|000047a0| 6e 64 72 6f 67 65 6e 20 | 65 78 63 65 73 73 2e 20 |ndrogen |excess. |
|000047b0| 20 54 68 69 73 0d 0a 68 | 79 70 6f 74 68 65 73 69 | This..h|ypothesi|
|000047c0| 73 20 77 61 73 20 65 78 | 61 6d 69 6e 65 64 20 69 |s was ex|amined i|
|000047d0| 6e 20 31 31 20 77 6f 6d | 65 6e 20 77 69 74 68 20 |n 11 wom|en with |
|000047e0| 68 69 72 73 75 74 69 73 | 6d 20 61 6e 64 20 6f 6c |hirsutis|m and ol|
|000047f0| 69 67 6f 6d 65 6e 6f 72 | 72 68 65 61 20 62 75 74 |igomenor|rhea but|
|00004800| 20 6e 6f 0d 0a 64 65 66 | 69 63 69 65 6e 63 79 20 | no..def|iciency |
|00004810| 6f 66 20 32 31 2d 68 79 | 64 72 6f 78 79 6c 61 73 |of 21-hy|droxylas|
|00004820| 65 20 6f 72 20 33 20 62 | 65 74 61 2d 68 79 64 72 |e or 3 b|eta-hydr|
|00004830| 6f 78 79 73 74 65 72 6f | 69 64 20 64 65 68 79 64 |oxystero|id dehyd|
|00004840| 72 6f 67 65 6e 61 73 65 | 2e 0d 0a 20 20 20 20 20 |rogenase|... |
|00004850| 50 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 50 43 |Patients| with PC|
|00004860| 4f 53 20 68 61 64 20 68 | 69 67 68 65 72 20 62 61 |OS had h|igher ba|
|00004870| 73 61 6c 20 70 6c 61 73 | 6d 61 20 6c 75 74 65 69 |sal plas|ma lutei|
|00004880| 6e 69 7a 69 6e 67 20 68 | 6f 72 6d 6f 6e 65 2c 0d |nizing h|ormone,.|
|00004890| 0a 61 6e 64 72 6f 73 74 | 65 6e 65 64 69 6f 6e 65 |.androst|enedione|
|000048a0| 2c 20 61 6e 64 20 74 65 | 73 74 6f 73 74 65 72 6f |, and te|stostero|
|000048b0| 6e 65 20 6c 65 76 65 6c | 73 20 74 68 61 6e 20 63 |ne level|s than c|
|000048c0| 6f 6e 74 72 6f 6c 73 2c | 20 62 75 74 20 63 6f 72 |ontrols,| but cor|
|000048d0| 74 69 73 6f 6c 20 6c 65 | 76 65 6c 73 0d 0a 77 65 |tisol le|vels..we|
|000048e0| 72 65 20 63 6f 6d 70 61 | 72 61 62 6c 65 2c 20 61 |re compa|rable, a|
|000048f0| 73 20 77 65 72 65 20 70 | 6c 61 73 6d 61 20 63 6f |s were p|lasma co|
|00004900| 72 74 69 73 6f 6c 20 72 | 65 73 70 6f 6e 73 65 73 |rtisol r|esponses|
|00004910| 20 74 6f 20 63 6f 72 74 | 69 63 6f 74 72 6f 70 69 | to cort|icotropi|
|00004920| 6e 2e 20 20 55 72 69 6e | 61 72 79 0d 0a 72 61 74 |n. Urin|ary..rat|
|00004930| 69 6f 73 20 6f 66 20 35 | 20 61 6c 70 68 61 20 74 |ios of 5| alpha t|
|00004940| 6f 20 35 20 62 65 74 61 | 20 63 6f 72 74 69 73 6f |o 5 beta| cortiso|
|00004950| 6c 20 6d 65 74 61 62 6f | 6c 69 74 65 73 20 77 65 |l metabo|lites we|
|00004960| 72 65 20 65 6c 65 76 61 | 74 65 64 20 69 6e 20 74 |re eleva|ted in t|
|00004970| 68 65 20 73 74 75 64 79 | 0d 0a 67 72 6f 75 70 2c |he study|..group,|
|00004980| 20 73 75 67 67 65 73 74 | 69 6e 67 20 65 6e 68 61 | suggest|ing enha|
|00004990| 6e 63 65 64 20 35 20 61 | 6c 70 68 61 2d 72 65 64 |nced 5 a|lpha-red|
|000049a0| 75 63 74 61 73 65 20 61 | 63 74 69 76 69 74 79 2e |uctase a|ctivity.|
|000049b0| 20 20 54 6f 74 61 6c 20 | 75 72 69 6e 61 72 79 20 | Total |urinary |
|000049c0| 63 6f 72 74 69 73 6f 6c | 0d 0a 6d 65 74 61 62 6f |cortisol|..metabo|
|000049d0| 6c 69 74 65 73 20 61 6c | 73 6f 20 77 65 72 65 20 |lites al|so were |
|000049e0| 69 6e 63 72 65 61 73 65 | 64 20 69 6e 20 74 68 65 |increase|d in the|
|000049f0| 20 73 75 62 6a 65 63 74 | 73 20 77 69 74 68 20 50 | subject|s with P|
|00004a00| 43 4f 53 2e 0d 0a 20 20 | 20 20 20 57 68 65 72 65 |COS... | Where|
|00004a10| 61 73 20 69 6e 74 65 72 | 63 6f 6e 76 65 72 73 69 |as inter|conversi|
|00004a20| 6f 6e 20 6f 66 20 63 6f | 72 74 69 73 6f 6c 20 61 |on of co|rtisol a|
|00004a30| 6e 64 20 63 6f 72 74 69 | 73 6f 6e 65 20 69 73 20 |nd corti|sone is |
|00004a40| 6e 6f 72 6d 61 6c 20 69 | 6e 20 50 43 4f 53 2c 20 |normal i|n PCOS, |
|00004a50| 35 0d 0a 61 6c 70 68 61 | 20 2d 72 65 64 75 63 74 |5..alpha| -reduct|
|00004a60| 61 73 65 20 61 63 74 69 | 76 69 74 79 20 69 73 20 |ase acti|vity is |
|00004a70| 69 6e 63 72 65 61 73 65 | 64 20 61 6e 64 20 6d 61 |increase|d and ma|
|00004a80| 79 20 6c 65 61 64 20 74 | 6f 20 65 6e 68 61 6e 63 |y lead t|o enhanc|
|00004a90| 65 64 20 63 6f 72 74 69 | 73 6f 6c 0d 0a 6d 65 74 |ed corti|sol..met|
|00004aa0| 61 62 6f 6c 69 73 6d 2e | 20 20 49 6e 63 72 65 61 |abolism.| Increa|
|00004ab0| 73 65 64 20 35 20 61 6c | 70 68 61 2d 72 65 64 75 |sed 5 al|pha-redu|
|00004ac0| 63 74 61 73 65 20 61 63 | 74 69 76 69 74 79 20 6d |ctase ac|tivity m|
|00004ad0| 61 79 20 62 65 20 74 68 | 65 20 62 61 73 69 63 20 |ay be th|e basic |
|00004ae0| 64 65 66 65 63 74 20 69 | 6e 0d 0a 6d 61 6e 79 20 |defect i|n..many |
|00004af0| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 50 43 |patients| with PC|
|00004b00| 4f 53 2c 20 6d 65 64 69 | 61 74 69 6e 67 20 62 6f |OS, medi|ating bo|
|00004b10| 74 68 20 68 69 72 73 75 | 74 69 73 6d 20 61 6e 64 |th hirsu|tism and|
|00004b20| 20 65 6e 68 61 6e 63 65 | 64 20 68 65 70 61 74 69 | enhance|d hepati|
|00004b30| 63 0d 0a 63 6f 72 74 69 | 73 6f 6c 20 6d 65 74 61 |c..corti|sol meta|
|00004b40| 62 6f 6c 69 73 6d 2e 20 | 20 41 20 63 6f 6e 63 6f |bolism. | A conco|
|00004b50| 6d 69 74 61 6e 74 20 72 | 69 73 65 20 69 6e 20 63 |mitant r|ise in c|
|00004b60| 6f 72 74 69 63 6f 74 72 | 6f 70 69 6e 20 73 65 63 |orticotr|opin sec|
|00004b70| 72 65 74 69 6f 6e 20 6d | 61 69 6e 74 61 69 6e 73 |retion m|aintains|
|00004b80| 0d 0a 61 20 6e 6f 72 6d | 61 6c 20 70 6c 61 73 6d |..a norm|al plasm|
|00004b90| 61 20 63 6f 72 74 69 73 | 6f 6c 20 6c 65 76 65 6c |a cortis|ol level|
|00004ba0| 20 61 74 20 74 68 65 20 | 65 78 70 65 6e 73 65 20 | at the |expense |
|00004bb0| 6f 66 20 61 6e 64 72 6f | 67 65 6e 20 65 78 63 65 |of andro|gen exce|
|00004bc0| 73 73 2e 0d 0a 0d 0a 50 | 6f 73 74 2d 43 6f 6d 6d |ss.....P|ost-Comm|
|00004bd0| 65 6e 74 0d 0a 0d 0a 20 | 20 20 20 20 54 68 69 73 |ent.... | This|
|00004be0| 20 69 73 20 61 6e 20 69 | 6e 74 65 72 65 73 74 69 | is an i|nteresti|
|00004bf0| 6e 67 20 68 79 70 6f 74 | 68 65 73 69 73 20 74 68 |ng hypot|hesis th|
|00004c00| 61 74 20 6e 65 65 64 73 | 20 74 6f 20 62 65 20 70 |at needs| to be p|
|00004c10| 72 6f 76 65 64 20 62 79 | 20 6d 65 61 73 75 72 69 |roved by| measuri|
|00004c20| 6e 67 0d 0a 74 68 65 20 | 35 20 61 6c 70 68 61 2d |ng..the |5 alpha-|
|00004c30| 72 65 64 75 63 74 61 73 | 65 20 61 63 74 69 76 69 |reductas|e activi|
|00004c40| 74 79 20 69 6e 20 73 6b | 69 6e 20 62 69 6f 70 73 |ty in sk|in biops|
|00004c50| 79 20 73 70 65 63 69 6d | 65 6e 73 2e 20 20 53 6f |y specim|ens. So|
|00004c60| 6d 65 20 77 6f 6d 65 6e | 20 77 69 74 68 20 77 68 |me women| with wh|
|00004c70| 61 74 0d 0a 77 61 73 20 | 70 72 65 76 69 6f 75 73 |at..was |previous|
|00004c80| 6c 79 20 74 65 72 6d 65 | 64 20 69 64 69 6f 70 61 |ly terme|d idiopa|
|00004c90| 74 68 69 63 20 68 69 72 | 73 75 74 69 73 6d 20 61 |thic hir|sutism a|
|00004ca0| 72 65 20 6e 6f 77 20 6b | 6e 6f 77 6e 20 74 6f 20 |re now k|nown to |
|00004cb0| 68 61 76 65 20 69 6e 63 | 72 65 61 73 65 64 20 35 |have inc|reased 5|
|00004cc0| 0d 0a 61 6c 70 68 61 2d | 72 65 64 75 63 74 61 73 |..alpha-|reductas|
|00004cd0| 65 20 61 63 74 69 76 69 | 74 79 2c 20 77 68 69 63 |e activi|ty, whic|
|00004ce0| 68 20 70 72 6f 64 75 63 | 65 73 20 65 78 63 65 73 |h produc|es exces|
|00004cf0| 73 20 68 61 69 72 20 67 | 72 6f 77 74 68 2e 20 20 |s hair g|rowth. |
|00004d00| 54 68 65 20 62 65 73 74 | 0d 0a 74 72 65 61 74 6d |The best|..treatm|
|00004d10| 65 6e 74 20 66 6f 72 20 | 74 68 69 73 20 64 69 73 |ent for |this dis|
|00004d20| 6f 72 64 65 72 20 69 73 | 20 73 70 69 72 6f 6e 6f |order is| spirono|
|00004d30| 6c 61 63 74 6f 6e 65 2c | 20 77 68 69 63 68 20 61 |lactone,| which a|
|00004d40| 63 74 73 20 74 6f 20 62 | 6c 6f 63 6b 20 61 6e 64 |cts to b|lock and|
|00004d50| 72 6f 67 65 6e 0d 0a 61 | 63 74 69 6f 6e 20 6f 6e |rogen..a|ction on|
|00004d60| 20 74 68 65 20 74 61 72 | 67 65 74 20 74 69 73 73 | the tar|get tiss|
|00004d70| 75 65 2e 2d 2d 44 2e 52 | 2e 20 4d 69 73 68 65 6c |ue.--D.R|. Mishel|
|00004d80| 6c 2c 20 4a 72 2e 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |l, Jr., |M.D...$U|
|00004d90| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 32 37 30 |nique_ID|{YRB0270|
|00004da0| 35 7d 0d 0a 24 54 69 74 | 6c 65 7b 41 6e 20 41 74 |5}..$Tit|le{An At|
|00004db0| 74 65 6d 70 74 20 74 6f | 20 41 6c 74 65 72 20 74 |tempt to| Alter t|
|00004dc0| 68 65 20 50 61 74 68 6f | 70 68 79 73 69 6f 6c 6f |he Patho|physiolo|
|00004dd0| 67 79 20 6f 66 20 50 6f | 6c 79 63 79 73 74 69 63 |gy of Po|lycystic|
|00004de0| 20 4f 76 61 72 79 20 53 | 79 6e 64 72 6f 6d 65 0d | Ovary S|yndrome.|
|00004df0| 0a 55 73 69 6e 67 20 61 | 20 47 6f 6e 61 64 6f 74 |.Using a| Gonadot|
|00004e00| 72 6f 70 68 69 6e 20 48 | 6f 72 6d 6f 6e 65 20 52 |rophin H|ormone R|
|00004e10| 65 6c 65 61 73 69 6e 67 | 20 48 6f 72 6d 6f 6e 65 |eleasing| Hormone|
|00004e20| 20 41 67 6f 6e 69 73 74 | 2c 20 4e 61 66 61 72 65 | Agonist|, Nafare|
|00004e30| 6c 69 6e 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 0d 0a |lin}..$A|uthor{..|
|00004e40| 57 69 6c 6c 69 61 6d 73 | 2c 20 49 41 0d 0a 53 68 |Williams|, IA..Sh|
|00004e50| 61 77 2c 20 52 57 0d 0a | 42 75 72 66 6f 72 64 2c |aw, RW..|Burford,|
|00004e60| 20 47 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f | G}..$Af|filiatio|
|00004e70| 6e 7b 52 6f 79 61 6c 20 | 46 72 65 65 20 48 6f 73 |n{Royal |Free Hos|
|00004e80| 70 2c 20 4c 6f 6e 64 6f | 6e 7d 0d 0a 24 4a 6f 75 |p, Londo|n}..$Jou|
|00004e90| 72 6e 61 6c 7b 43 6c 69 | 6e 20 45 6e 64 6f 63 72 |rnal{Cli|n Endocr|
|00004ea0| 69 6e 6f 6c 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 |inol}..$|Volume{3|
|00004eb0| 31 7d 0d 0a 24 50 61 67 | 65 7b 33 34 35 2d 33 35 |1}..$Pag|e{345-35|
|00004ec0| 33 7d 0d 0a 24 44 61 74 | 65 7b 31 39 38 39 7d 0d |3}..$Dat|e{1989}.|
|00004ed0| 0a 24 59 42 56 6f 6c 7b | 31 39 39 31 20 59 65 61 |.$YBVol{|1991 Yea|
|00004ee0| 72 20 42 6f 6f 6b 20 6f | 66 20 4f 62 73 74 65 74 |r Book o|f Obstet|
|00004ef0| 72 69 63 73 20 61 6e 64 | 20 47 79 6e 65 63 6f 6c |rics and| Gynecol|
|00004f00| 6f 67 79 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 31 |ogy}..$C|hapter{1|
|00004f10| 35 2d 31 35 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |5-15}..$|YBEditor|
|00004f20| 7b 44 72 73 2e 20 4d 69 | 73 68 65 6c 6c 2c 20 4b |{Drs. Mi|shell, K|
|00004f30| 69 72 73 63 68 62 61 75 | 6d 2c 20 61 6e 64 20 4d |irschbau|m, and M|
|00004f40| 6f 72 72 6f 77 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |orrow}..|$Table{}|
|00004f50| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 44 |..$Comme|ntator{D|
|00004f60| 2e 52 2e 20 4d 69 73 68 | 65 6c 6c 2c 20 4a 72 2e |.R. Mish|ell, Jr.|
|00004f70| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00004f80| 69 67 68 74 20 28 43 29 | 20 59 65 61 72 20 42 6f |ight (C)| Year Bo|
|00004f90| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00004fa0| 73 68 65 72 73 2c 20 49 | 6e 63 2e 20 31 39 39 31 |shers, I|nc. 1991|
|00004fb0| 0d 0a 0d 0a 31 39 39 31 | 20 59 65 61 72 20 42 6f |....1991| Year Bo|
|00004fc0| 6f 6b 20 6f 66 20 4f 62 | 73 74 65 74 72 69 63 73 |ok of Ob|stetrics|
|00004fd0| 20 61 6e 64 20 47 79 6e | 65 63 6f 6c 6f 67 79 0d | and Gyn|ecology.|
|00004fe0| 0a 0d 0a 47 79 6e 65 63 | 6f 6c 6f 67 79 0d 0a 0d |...Gynec|ology...|
|00004ff0| 0a 43 68 61 70 74 65 72 | 20 31 35 20 2d 2d 20 45 |.Chapter| 15 -- E|
|00005000| 6e 64 6f 63 72 69 6e 6f | 6c 6f 67 79 0d 0a 0d 0a |ndocrino|logy....|
|00005010| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005040| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005050| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00005060| 41 6e 20 41 74 74 65 6d | 70 74 20 74 6f 20 41 6c |An Attem|pt to Al|
|00005070| 74 65 72 20 74 68 65 20 | 50 61 74 68 6f 70 68 79 |ter the |Pathophy|
|00005080| 73 69 6f 6c 6f 67 79 20 | 6f 66 20 50 6f 6c 79 63 |siology |of Polyc|
|00005090| 79 73 74 69 63 20 4f 76 | 61 72 79 20 53 79 6e 64 |ystic Ov|ary Synd|
|000050a0| 72 6f 6d 65 20 55 73 69 | 6e 67 20 61 0d 0a 47 6f |rome Usi|ng a..Go|
|000050b0| 6e 61 64 6f 74 72 6f 70 | 68 69 6e 20 48 6f 72 6d |nadotrop|hin Horm|
|000050c0| 6f 6e 65 20 52 65 6c 65 | 61 73 69 6e 67 20 48 6f |one Rele|asing Ho|
|000050d0| 72 6d 6f 6e 65 20 41 67 | 6f 6e 69 73 74 2c 20 4e |rmone Ag|onist, N|
|000050e0| 61 66 61 72 65 6c 69 6e | 0d 0a 0d 0a 57 69 6c 6c |afarelin|....Will|
|000050f0| 69 61 6d 73 20 49 41 3b | 20 53 68 61 77 20 52 57 |iams IA;| Shaw RW|
|00005100| 3b 20 42 75 72 66 6f 72 | 64 20 47 0d 0a 28 52 6f |; Burfor|d G..(Ro|
|00005110| 79 61 6c 20 46 72 65 65 | 20 48 6f 73 70 2c 20 4c |yal Free| Hosp, L|
|00005120| 6f 6e 64 6f 6e 29 0d 0a | 43 6c 69 6e 20 45 6e 64 |ondon)..|Clin End|
|00005130| 6f 63 72 69 6e 6f 6c 20 | 33 31 3a 33 34 35 2d 33 |ocrinol |31:345-3|
|00005140| 35 33 2c 20 31 39 38 39 | 0d 0a 2d 2d 2d 2d 2d 2d |53, 1989|..------|
|00005150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005170| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005180| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005190| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|000051a0| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 54 6f 20 |ract....| To |
|000051b0| 64 65 74 65 72 6d 69 6e | 65 20 77 68 65 74 68 65 |determin|e whethe|
|000051c0| 72 20 74 68 65 20 70 61 | 74 68 6f 70 68 79 73 69 |r the pa|thophysi|
|000051d0| 6f 6c 6f 67 79 20 6f 66 | 20 70 6f 6c 79 63 79 73 |ology of| polycys|
|000051e0| 74 69 63 20 6f 76 61 72 | 79 20 73 79 6e 64 72 6f |tic ovar|y syndro|
|000051f0| 6d 65 0d 0a 28 50 43 4f | 53 29 20 63 61 6e 20 62 |me..(PCO|S) can b|
|00005200| 65 20 63 68 61 6e 67 65 | 64 20 62 79 20 73 75 70 |e change|d by sup|
|00005210| 70 72 65 73 73 69 6e 67 | 20 74 68 65 20 61 62 6e |pressing| the abn|
|00005220| 6f 72 6d 61 6c 20 63 79 | 63 6c 65 20 6f 66 20 65 |ormal cy|cle of e|
|00005230| 76 65 6e 74 73 20 61 73 | 73 6f 63 69 61 74 65 64 |vents as|sociated|
|00005240| 0d 0a 77 69 74 68 20 61 | 62 6e 6f 72 6d 61 6c 20 |..with a|bnormal |
|00005250| 67 6f 6e 61 64 6f 74 72 | 6f 70 69 6e 73 20 61 6e |gonadotr|opins an|
|00005260| 64 20 61 6e 64 72 6f 67 | 65 6e 73 2c 20 31 35 20 |d androg|ens, 15 |
|00005270| 77 6f 6d 65 6e 20 77 69 | 74 68 20 50 43 4f 53 20 |women wi|th PCOS |
|00005280| 77 65 72 65 20 74 72 65 | 61 74 65 64 0d 0a 77 69 |were tre|ated..wi|
|00005290| 74 68 20 74 68 65 20 67 | 6f 6e 61 64 6f 74 72 6f |th the g|onadotro|
|000052a0| 70 69 6e 2d 72 65 6c 65 | 61 73 69 6e 67 20 68 6f |pin-rele|asing ho|
|000052b0| 72 6d 6f 6e 65 20 61 67 | 6f 6e 69 73 74 20 6e 61 |rmone ag|onist na|
|000052c0| 66 61 72 65 6c 69 6e 2c | 20 32 30 30 20 6d 75 5f |farelin,| 200 mu_|
|000052d0| 67 20 74 77 69 63 65 0d | 0a 64 61 69 6c 79 20 69 |g twice.|.daily i|
|000052e0| 6e 74 72 61 6e 61 73 61 | 6c 6c 79 20 66 6f 72 20 |ntranasa|lly for |
|000052f0| 33 20 6d 6f 6e 74 68 73 | 20 6f 72 20 36 20 6d 6f |3 months| or 6 mo|
|00005300| 6e 74 68 73 2e 20 20 41 | 20 64 65 78 61 6d 65 74 |nths. A| dexamet|
|00005310| 68 61 73 6f 6e 65 20 73 | 75 70 70 72 65 73 73 69 |hasone s|uppressi|
|00005320| 6f 6e 20 74 65 73 74 0d | 0a 28 2e 35 20 6d 67 20 |on test.|.(.5 mg |
|00005330| 34 20 74 69 6d 65 73 20 | 61 20 64 61 79 20 66 6f |4 times |a day fo|
|00005340| 72 20 34 38 20 68 6f 75 | 72 73 29 20 77 61 73 20 |r 48 hou|rs) was |
|00005350| 61 64 6d 69 6e 69 73 74 | 65 72 65 64 20 74 6f 20 |administ|ered to |
|00005360| 38 20 77 6f 6d 65 6e 20 | 62 65 66 6f 72 65 20 61 |8 women |before a|
|00005370| 6e 64 0d 0a 61 66 74 65 | 72 20 6e 61 66 61 72 65 |nd..afte|r nafare|
|00005380| 6c 69 6e 20 74 72 65 61 | 74 6d 65 6e 74 20 74 6f |lin trea|tment to|
|00005390| 20 64 69 66 66 65 72 65 | 6e 74 69 61 74 65 20 62 | differe|ntiate b|
|000053a0| 65 74 77 65 65 6e 20 61 | 6e 20 61 64 72 65 6e 61 |etween a|n adrena|
|000053b0| 6c 20 61 6e 64 20 61 6e | 20 6f 76 61 72 69 61 6e |l and an| ovarian|
|000053c0| 0d 0a 73 6f 75 72 63 65 | 20 6f 66 20 74 68 65 20 |..source| of the |
|000053d0| 65 78 63 65 73 73 20 61 | 6e 64 72 6f 67 65 6e 73 |excess a|ndrogens|
|000053e0| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 74 72 65 61 |... |The trea|
|000053f0| 74 6d 65 6e 74 20 73 75 | 70 70 72 65 73 73 65 64 |tment su|ppressed|
|00005400| 20 67 6f 6e 61 64 6f 74 | 72 6f 70 69 6e 73 20 61 | gonadot|ropins a|
|00005410| 6e 64 20 61 6e 64 72 6f | 67 65 6e 73 20 77 65 6c |nd andro|gens wel|
|00005420| 6c 3b 20 74 68 65 0d 0a | 6c 75 74 65 69 6e 69 7a |l; the..|luteiniz|
|00005430| 69 6e 67 20 68 6f 72 6d | 6f 6e 65 20 6c 65 76 65 |ing horm|one leve|
|00005440| 6c 20 77 61 73 20 64 65 | 63 72 65 61 73 65 64 20 |l was de|creased |
|00005450| 74 6f 20 61 20 6d 65 61 | 6e 20 31 2e 35 20 49 55 |to a mea|n 1.5 IU|
|00005460| 2f 4c 2c 20 74 65 73 74 | 6f 73 74 65 72 6f 6e 65 |/L, test|osterone|
|00005470| 20 74 6f 0d 0a 31 2e 31 | 20 6e 6d 6f 6c 2f 4c 2c | to..1.1| nmol/L,|
|00005480| 20 61 6e 64 20 61 6e 64 | 72 6f 73 74 65 6e 65 64 | and and|rostened|
|00005490| 69 6f 6e 65 20 74 6f 20 | 36 2e 34 20 6e 6d 6f 6c |ione to |6.4 nmol|
|000054a0| 2f 4c 2e 20 20 41 6c 6c | 20 6f 66 20 74 68 65 73 |/L. All| of thes|
|000054b0| 65 20 68 6f 72 6d 6f 6e | 65 73 20 72 65 74 75 72 |e hormon|es retur|
|000054c0| 6e 65 64 0d 0a 74 6f 20 | 62 61 73 65 6c 69 6e 65 |ned..to |baseline|
|000054d0| 20 6c 65 76 65 6c 73 20 | 77 69 74 68 69 6e 20 33 | levels |within 3|
|000054e0| 20 6d 6f 6e 74 68 73 20 | 61 66 74 65 72 20 6e 61 | months |after na|
|000054f0| 66 61 72 65 6c 69 6e 20 | 74 72 65 61 74 6d 65 6e |farelin |treatmen|
|00005500| 74 20 77 61 73 20 73 74 | 6f 70 70 65 64 2e 20 20 |t was st|opped. |
|00005510| 4e 6f 0d 0a 63 6f 6e 73 | 69 73 74 65 6e 74 20 72 |No..cons|istent r|
|00005520| 65 64 75 63 74 69 6f 6e | 20 69 6e 20 6f 76 61 72 |eduction| in ovar|
|00005530| 69 61 6e 20 76 6f 6c 75 | 6d 65 20 77 61 73 20 6f |ian volu|me was o|
|00005540| 62 73 65 72 76 65 64 2c | 20 6e 6f 72 20 64 69 64 |bserved,| nor did|
|00005550| 20 74 68 65 20 6f 76 61 | 72 69 61 6e 0d 0a 66 6f | the ova|rian..fo|
|00005560| 6c 6c 69 63 6c 65 73 20 | 64 69 73 61 70 70 65 61 |llicles |disappea|
|00005570| 72 20 66 72 6f 6d 20 75 | 6c 74 72 61 73 6f 6e 6f |r from u|ltrasono|
|00005580| 67 72 61 70 68 69 63 20 | 76 69 65 77 2e 20 20 41 |graphic |view. A|
|00005590| 20 73 6c 69 67 68 74 20 | 69 6d 70 72 6f 76 65 6d | slight |improvem|
|000055a0| 65 6e 74 20 69 6e 0d 0a | 68 69 72 73 75 74 69 73 |ent in..|hirsutis|
|000055b0| 6d 20 77 61 73 20 6e 6f | 74 65 64 20 69 6e 20 34 |m was no|ted in 4|
|000055c0| 20 6f 66 20 37 20 77 6f | 6d 65 6e 2e 20 20 41 66 | of 7 wo|men. Af|
|000055d0| 74 65 72 20 74 68 65 20 | 74 72 65 61 74 6d 65 6e |ter the |treatmen|
|000055e0| 74 20 31 20 6f 66 20 74 | 68 65 20 38 20 77 6f 6d |t 1 of t|he 8 wom|
|000055f0| 65 6e 0d 0a 77 69 74 68 | 20 69 6e 66 65 72 74 69 |en..with| inferti|
|00005600| 6c 69 74 79 20 63 6f 6e | 63 65 69 76 65 64 20 73 |lity con|ceived s|
|00005610| 70 6f 6e 74 61 6e 65 6f | 75 73 6c 79 2c 20 61 6e |pontaneo|usly, an|
|00005620| 64 20 31 20 6f 76 75 6c | 61 74 65 64 20 77 69 74 |d 1 ovul|ated wit|
|00005630| 68 20 61 20 72 65 64 75 | 63 65 64 20 64 6f 73 61 |h a redu|ced dosa|
|00005640| 67 65 0d 0a 6f 66 20 63 | 6c 6f 6d 69 70 68 65 6e |ge..of c|lomiphen|
|00005650| 65 2e 20 20 54 68 65 72 | 65 20 77 65 72 65 20 6e |e. Ther|e were n|
|00005660| 6f 20 63 68 61 6e 67 65 | 73 20 69 6e 20 74 68 65 |o change|s in the|
|00005670| 20 6d 65 6e 73 74 72 75 | 61 6c 20 70 61 74 74 65 | menstru|al patte|
|00005680| 72 6e 73 20 6f 66 20 74 | 68 65 20 6f 74 68 65 72 |rns of t|he other|
|00005690| 73 2e 0d 0a 20 20 20 20 | 20 41 6c 74 68 6f 75 67 |s... | Althoug|
|000056a0| 68 20 6e 61 66 61 72 65 | 6c 69 6e 20 73 75 63 63 |h nafare|lin succ|
|000056b0| 65 73 73 66 75 6c 6c 79 | 20 73 75 70 70 72 65 73 |essfully| suppres|
|000056c0| 73 65 64 20 62 6f 74 68 | 20 67 6f 6e 61 64 6f 74 |sed both| gonadot|
|000056d0| 72 6f 70 69 6e 73 20 61 | 6e 64 0d 0a 61 6e 64 72 |ropins a|nd..andr|
|000056e0| 6f 67 65 6e 73 2c 20 74 | 68 65 73 65 20 68 6f 72 |ogens, t|hese hor|
|000056f0| 6d 6f 6e 65 73 20 72 61 | 70 69 64 6c 79 20 72 65 |mones ra|pidly re|
|00005700| 74 75 72 6e 65 64 20 74 | 6f 20 74 68 65 69 72 20 |turned t|o their |
|00005710| 61 62 6e 6f 72 6d 61 6c | 20 6c 65 76 65 6c 73 20 |abnormal| levels |
|00005720| 61 66 74 65 72 0d 0a 74 | 72 65 61 74 6d 65 6e 74 |after..t|reatment|
|00005730| 20 77 61 73 20 64 69 73 | 63 6f 6e 74 69 6e 75 65 | was dis|continue|
|00005740| 64 2e 20 20 54 68 65 20 | 70 72 69 6d 61 72 79 20 |d. The |primary |
|00005750| 63 68 61 6e 67 65 20 69 | 6e 20 50 43 4f 53 20 64 |change i|n PCOS d|
|00005760| 6f 65 73 20 6e 6f 74 20 | 61 70 70 65 61 72 20 74 |oes not |appear t|
|00005770| 6f 20 62 65 0d 0a 61 20 | 63 6f 6e 73 69 73 74 65 |o be..a |consiste|
|00005780| 6e 74 20 65 76 65 6e 74 | 2c 20 77 68 65 74 68 65 |nt event|, whethe|
|00005790| 72 20 69 74 20 62 65 20 | 61 74 20 74 68 65 20 6f |r it be |at the o|
|000057a0| 76 61 72 69 61 6e 2c 20 | 70 69 74 75 69 74 61 72 |varian, |pituitar|
|000057b0| 79 2c 20 6f 72 20 68 79 | 70 6f 74 68 61 6c 61 6d |y, or hy|pothalam|
|000057c0| 69 63 0d 0a 6c 65 76 65 | 6c 2c 20 61 6e 64 20 63 |ic..leve|l, and c|
|000057d0| 61 6e 6e 6f 74 20 62 65 | 20 63 68 61 6e 67 65 64 |annot be| changed|
|000057e0| 20 62 79 20 62 72 65 61 | 6b 69 6e 67 20 74 68 65 | by brea|king the|
|000057f0| 20 63 79 63 6c 65 20 6f | 66 20 65 76 65 6e 74 73 | cycle o|f events|
|00005800| 20 62 79 20 73 75 70 70 | 72 65 73 73 69 6e 67 0d | by supp|ressing.|
|00005810| 0a 67 6f 6e 61 64 6f 74 | 72 6f 70 69 6e 73 20 61 |.gonadot|ropins a|
|00005820| 6e 64 20 61 6e 64 72 6f | 67 65 6e 73 2e 0d 0a 0d |nd andro|gens....|
|00005830| 0a 50 6f 73 74 2d 43 6f | 6d 6d 65 6e 74 0d 0a 0d |.Post-Co|mment...|
|00005840| 0a 20 20 20 20 20 55 73 | 65 20 6f 66 20 61 20 67 |. Us|e of a g|
|00005850| 6f 6e 61 64 6f 74 72 6f | 70 69 6e 2d 72 65 6c 65 |onadotro|pin-rele|
|00005860| 61 73 69 6e 67 20 68 6f | 72 6d 6f 6e 65 20 28 47 |asing ho|rmone (G|
|00005870| 6e 52 48 29 20 61 67 6f | 6e 69 73 74 20 61 6c 6f |nRH) ago|nist alo|
|00005880| 6e 65 20 66 6f 72 20 33 | 2d 36 0d 0a 6d 6f 6e 74 |ne for 3|-6..mont|
|00005890| 68 73 20 77 69 74 68 6f | 75 74 20 62 65 69 6e 67 |hs witho|ut being|
|000058a0| 20 66 6f 6c 6c 6f 77 65 | 64 20 62 79 20 65 69 74 | followe|d by eit|
|000058b0| 68 65 72 20 68 75 6d 61 | 6e 20 6d 65 6e 6f 70 61 |her huma|n menopa|
|000058c0| 75 73 61 6c 20 67 6f 6e | 61 64 6f 74 72 6f 70 69 |usal gon|adotropi|
|000058d0| 6e 20 6f 72 0d 0a 70 75 | 6c 73 61 74 69 6c 65 20 |n or..pu|lsatile |
|000058e0| 47 6e 52 48 20 64 69 64 | 20 6e 6f 74 20 72 65 73 |GnRH did| not res|
|000058f0| 75 6c 74 20 69 6e 20 6d | 6f 72 65 20 74 68 61 6e |ult in m|ore than|
|00005900| 20 61 6e 20 6f 63 63 61 | 73 69 6f 6e 61 6c 20 6f | an occa|sional o|
|00005910| 76 75 6c 61 74 69 6f 6e | 20 61 66 74 65 72 20 47 |vulation| after G|
|00005920| 6e 52 68 0d 0a 77 61 73 | 20 64 69 73 63 6f 6e 74 |nRh..was| discont|
|00005930| 69 6e 75 65 64 2e 20 20 | 54 68 69 73 20 62 72 65 |inued. |This bre|
|00005940| 61 6b 69 6e 67 20 6f 66 | 20 74 68 65 20 76 69 63 |aking of| the vic|
|00005950| 69 6f 75 73 20 63 79 63 | 6c 65 20 6f 66 20 65 6e |ious cyc|le of en|
|00005960| 64 6f 63 72 69 6e 6f 6c | 6f 67 69 63 0d 0a 63 68 |docrinol|ogic..ch|
|00005970| 61 6e 67 65 73 20 69 6e | 20 50 43 4f 53 20 62 79 |anges in| PCOS by|
|00005980| 20 74 65 6d 70 6f 72 61 | 72 69 6c 79 20 73 75 70 | tempora|rily sup|
|00005990| 70 72 65 73 73 69 6e 67 | 20 67 6f 6e 61 64 6f 74 |pressing| gonadot|
|000059a0| 72 6f 70 69 6e 20 61 6e | 64 20 61 6e 64 72 6f 73 |ropin an|d andros|
|000059b0| 74 65 6e 65 64 69 6f 6e | 65 0d 0a 65 78 63 72 65 |tenedion|e..excre|
|000059c0| 74 69 6f 6e 20 69 73 20 | 6e 6f 74 20 61 73 20 65 |tion is |not as e|
|000059d0| 66 66 65 63 74 69 76 65 | 20 61 73 20 77 68 65 6e |ffective| as when|
|000059e0| 20 69 74 20 6f 63 63 75 | 72 73 20 61 66 74 65 72 | it occu|rs after|
|000059f0| 20 70 61 72 74 69 61 6c | 20 6f 76 61 72 69 61 6e | partial| ovarian|
|00005a00| 0d 0a 64 65 73 66 72 61 | 63 74 69 6f 6e 20 62 79 |..desfra|ction by|
|00005a10| 20 77 65 64 67 65 20 72 | 65 73 65 63 74 69 6f 6e | wedge r|esection|
|00005a20| 20 6f 72 20 6d 75 6c 74 | 69 70 6c 65 20 65 6c 65 | or mult|iple ele|
|00005a30| 63 74 72 6f 63 61 75 74 | 65 72 79 2e 20 20 50 65 |ctrocaut|ery. Pe|
|00005a40| 72 68 61 70 73 20 74 68 | 65 0d 0a 64 69 66 66 65 |rhaps th|e..diffe|
|00005a50| 72 65 6e 63 65 20 69 73 | 20 64 75 65 20 74 6f 20 |rence is| due to |
|00005a60| 74 68 65 20 66 61 63 74 | 20 74 68 61 74 20 65 73 |the fact| that es|
|00005a70| 74 72 61 64 69 6f 6c 20 | 73 65 63 72 65 74 69 6f |tradiol |secretio|
|00005a80| 6e 20 69 73 20 61 6c 73 | 6f 20 73 75 70 70 72 65 |n is als|o suppre|
|00005a90| 73 73 65 64 20 77 69 74 | 68 0d 0a 75 73 65 20 6f |ssed wit|h..use o|
|00005aa0| 66 20 74 68 65 20 61 67 | 6f 6e 69 73 74 20 62 75 |f the ag|onist bu|
|00005ab0| 74 20 6e 6f 74 20 61 66 | 74 65 72 20 70 61 72 74 |t not af|ter part|
|00005ac0| 69 61 6c 20 6f 76 61 72 | 69 61 6e 20 64 65 73 74 |ial ovar|ian dest|
|00005ad0| 72 75 63 74 69 6f 6e 2e | 2d 2d 44 2e 52 2e 20 4d |ruction.|--D.R. M|
|00005ae0| 69 73 68 65 6c 6c 2c 0d | 0a 4a 72 2e 2c 20 4d 2e |ishell,.|.Jr., M.|
|00005af0| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00005b00| 52 42 30 32 37 30 36 7d | 0d 0a 24 54 69 74 6c 65 |RB02706}|..$Title|
|00005b10| 7b 46 61 6d 69 6c 69 61 | 6c 20 43 6c 75 73 74 65 |{Familia|l Cluste|
|00005b20| 72 69 6e 67 20 69 6e 20 | 74 68 65 20 50 6f 6c 79 |ring in |the Poly|
|00005b30| 63 79 73 74 69 63 20 4f | 76 61 72 69 61 6e 20 53 |cystic O|varian S|
|00005b40| 79 6e 64 72 6f 6d 65 7d | 0d 0a 24 41 75 74 68 6f |yndrome}|..$Autho|
|00005b50| 72 7b 0d 0a 4c 75 6e 64 | 65 2c 20 4f 0d 0a 4d 61 |r{..Lund|e, O..Ma|
|00005b60| 67 6e 75 73 2c 20 50 0d | 0a 53 61 6e 64 76 69 6b |gnus, P.|.Sandvik|
|00005b70| 2c 20 4c 0d 0a 48 6f 67 | 6c 6f 2c 20 53 7d 0d 0a |, L..Hog|lo, S}..|
|00005b80| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 55 6e 69 |$Affilia|tion{Uni|
|00005b90| 76 20 6f 66 20 4f 73 6c | 6f 3b 20 4e 61 74 6c 20 |v of Osl|o; Natl |
|00005ba0| 49 6e 73 74 20 6f 66 20 | 50 75 62 6c 69 63 20 48 |Inst of |Public H|
|00005bb0| 65 61 6c 74 68 2c 20 4f | 73 6c 6f 3b 20 4d 65 64 |ealth, O|slo; Med|
|00005bc0| 73 74 61 74 2c 20 53 74 | 72 6f 6d 6d 61 6e 2c 20 |stat, St|romman, |
|00005bd0| 4e 6f 72 77 61 79 7d 0d | 0a 24 4a 6f 75 72 6e 61 |Norway}.|.$Journa|
|00005be0| 6c 7b 47 79 6e 65 63 6f | 6c 20 4f 62 73 74 65 74 |l{Gyneco|l Obstet|
|00005bf0| 20 49 6e 76 65 73 74 7d | 0d 0a 24 56 6f 6c 75 6d | Invest}|..$Volum|
|00005c00| 65 7b 32 38 7d 0d 0a 24 | 50 61 67 65 7b 32 33 2d |e{28}..$|Page{23-|
|00005c10| 33 30 7d 0d 0a 24 44 61 | 74 65 7b 31 39 38 39 7d |30}..$Da|te{1989}|
|00005c20| 0d 0a 24 59 42 56 6f 6c | 7b 31 39 39 31 20 59 65 |..$YBVol|{1991 Ye|
|00005c30| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 4f 62 73 74 65 |ar Book |of Obste|
|00005c40| 74 72 69 63 73 20 61 6e | 64 20 47 79 6e 65 63 6f |trics an|d Gyneco|
|00005c50| 6c 6f 67 79 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b |logy}..$|Chapter{|
|00005c60| 31 35 2d 31 36 7d 0d 0a | 24 59 42 45 64 69 74 6f |15-16}..|$YBEdito|
|00005c70| 72 7b 44 72 73 2e 20 4d | 69 73 68 65 6c 6c 2c 20 |r{Drs. M|ishell, |
|00005c80| 4b 69 72 73 63 68 62 61 | 75 6d 2c 20 61 6e 64 20 |Kirschba|um, and |
|00005c90| 4d 6f 72 72 6f 77 7d 0d | 0a 24 54 61 62 6c 65 7b |Morrow}.|.$Table{|
|00005ca0| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00005cb0| 44 2e 52 2e 20 4d 69 73 | 68 65 6c 6c 2c 20 4a 72 |D.R. Mis|hell, Jr|
|00005cc0| 2e 2c 20 4d 2e 44 2e 7d | 0d 0a 0d 0a 43 6f 70 79 |., M.D.}|....Copy|
|00005cd0| 72 69 67 68 74 20 28 43 | 29 20 59 65 61 72 20 42 |right (C|) Year B|
|00005ce0| 6f 6f 6b 20 4d 65 64 69 | 63 61 6c 20 50 75 62 6c |ook Medi|cal Publ|
|00005cf0| 69 73 68 65 72 73 2c 20 | 49 6e 63 2e 20 31 39 39 |ishers, |Inc. 199|
|00005d00| 31 0d 0a 0d 0a 31 39 39 | 31 20 59 65 61 72 20 42 |1....199|1 Year B|
|00005d10| 6f 6f 6b 20 6f 66 20 4f | 62 73 74 65 74 72 69 63 |ook of O|bstetric|
|00005d20| 73 20 61 6e 64 20 47 79 | 6e 65 63 6f 6c 6f 67 79 |s and Gy|necology|
|00005d30| 0d 0a 0d 0a 47 79 6e 65 | 63 6f 6c 6f 67 79 0d 0a |....Gyne|cology..|
|00005d40| 0d 0a 43 68 61 70 74 65 | 72 20 31 35 20 2d 2d 20 |..Chapte|r 15 -- |
|00005d50| 45 6e 64 6f 63 72 69 6e | 6f 6c 6f 67 79 0d 0a 0d |Endocrin|ology...|
|00005d60| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00005d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005d80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005d90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005da0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00005db0| 0a 46 61 6d 69 6c 69 61 | 6c 20 43 6c 75 73 74 65 |.Familia|l Cluste|
|00005dc0| 72 69 6e 67 20 69 6e 20 | 74 68 65 20 50 6f 6c 79 |ring in |the Poly|
|00005dd0| 63 79 73 74 69 63 20 4f | 76 61 72 69 61 6e 20 53 |cystic O|varian S|
|00005de0| 79 6e 64 72 6f 6d 65 0d | 0a 0d 0a 4c 75 6e 64 65 |yndrome.|...Lunde|
|00005df0| 20 4f 3b 20 4d 61 67 6e | 75 73 20 50 3b 20 53 61 | O; Magn|us P; Sa|
|00005e00| 6e 64 76 69 6b 20 4c 3b | 20 48 6f 67 6c 6f 20 53 |ndvik L;| Hoglo S|
|00005e10| 0d 0a 28 55 6e 69 76 20 | 6f 66 20 4f 73 6c 6f 3b |..(Univ |of Oslo;|
|00005e20| 20 4e 61 74 6c 20 49 6e | 73 74 20 6f 66 20 50 75 | Natl In|st of Pu|
|00005e30| 62 6c 69 63 20 48 65 61 | 6c 74 68 2c 20 4f 73 6c |blic Hea|lth, Osl|
|00005e40| 6f 3b 20 4d 65 64 73 74 | 61 74 2c 20 53 74 72 6f |o; Medst|at, Stro|
|00005e50| 6d 6d 61 6e 2c 20 4e 6f | 72 77 61 79 29 0d 0a 47 |mman, No|rway)..G|
|00005e60| 79 6e 65 63 6f 6c 20 4f | 62 73 74 65 74 20 49 6e |ynecol O|bstet In|
|00005e70| 76 65 73 74 20 32 38 3a | 32 33 2d 33 30 2c 20 31 |vest 28:|23-30, 1|
|00005e80| 39 38 39 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |989..---|--------|
|00005e90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ea0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005eb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ec0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ed0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00005ee0| 0a 0d 0a 20 20 20 20 20 | 54 6f 20 61 73 73 65 73 |... |To asses|
|00005ef0| 73 20 74 68 65 20 64 65 | 67 72 65 65 20 6f 66 20 |s the de|gree of |
|00005f00| 66 61 6d 69 6c 69 61 6c | 20 63 6c 75 73 74 65 72 |familial| cluster|
|00005f10| 69 6e 67 20 61 6e 64 20 | 6d 6f 64 65 20 6f 66 20 |ing and |mode of |
|00005f20| 69 6e 68 65 72 69 74 61 | 6e 63 65 20 6f 66 0d 0a |inherita|nce of..|
|00005f30| 70 6f 6c 79 63 79 73 74 | 69 63 20 6f 76 61 72 69 |polycyst|ic ovari|
|00005f40| 61 6e 20 73 79 6e 64 72 | 6f 6d 65 20 28 50 43 4f |an syndr|ome (PCO|
|00005f50| 53 29 2c 20 74 68 65 20 | 70 72 65 76 61 6c 65 6e |S), the |prevalen|
|00005f60| 63 65 20 6f 66 20 50 43 | 4f 53 2d 72 65 6c 61 74 |ce of PC|OS-relat|
|00005f70| 65 64 20 73 79 6d 70 74 | 6f 6d 73 0d 0a 77 65 72 |ed sympt|oms..wer|
|00005f80| 65 20 73 74 75 64 69 65 | 64 20 69 6e 20 66 69 72 |e studie|d in fir|
|00005f90| 73 74 2d 20 61 6e 64 20 | 73 65 63 6f 6e 64 2d 64 |st- and |second-d|
|00005fa0| 65 67 72 65 65 20 72 65 | 6c 61 74 69 76 65 73 20 |egree re|latives |
|00005fb0| 6f 66 20 31 33 32 20 70 | 61 74 69 65 6e 74 73 20 |of 132 p|atients |
|00005fc0| 77 69 74 68 20 50 43 4f | 53 0d 0a 61 6e 64 20 37 |with PCO|S..and 7|
|00005fd0| 31 20 63 6f 6e 74 72 6f | 6c 73 2e 0d 0a 20 20 20 |1 contro|ls... |
|00005fe0| 20 20 41 6e 61 6c 79 73 | 69 73 20 6f 66 20 74 68 | Analys|is of th|
|00005ff0| 65 20 71 75 65 73 74 69 | 6f 6e 6e 61 69 72 65 20 |e questi|onnaire |
|00006000| 64 61 74 61 20 69 6e 64 | 69 63 61 74 65 64 20 74 |data ind|icated t|
|00006010| 68 61 74 20 74 68 65 20 | 70 72 65 76 61 6c 65 6e |hat the |prevalen|
|00006020| 63 65 20 6f 66 20 65 61 | 72 6c 79 0d 0a 62 61 6c |ce of ea|rly..bal|
|00006030| 64 6e 65 73 73 20 6f 72 | 20 65 78 63 65 73 73 69 |dness or| excessi|
|00006040| 76 65 20 68 61 69 72 69 | 6e 65 73 73 20 77 61 73 |ve hairi|ness was|
|00006050| 20 73 69 67 6e 69 66 69 | 63 61 6e 74 6c 79 20 68 | signifi|cantly h|
|00006060| 69 67 68 65 72 20 69 6e | 20 6d 61 6c 65 20 66 69 |igher in| male fi|
|00006070| 72 73 74 2d 64 65 67 72 | 65 65 0d 0a 72 65 6c 61 |rst-degr|ee..rela|
|00006080| 74 69 76 65 73 20 6f 66 | 20 70 61 74 69 65 6e 74 |tives of| patient|
|00006090| 73 20 77 69 74 68 20 50 | 43 4f 53 20 74 68 61 6e |s with P|COS than|
|000060a0| 20 69 6e 20 63 6f 6e 74 | 72 6f 6c 73 20 28 31 39 | in cont|rols (19|
|000060b0| 2e 37 25 20 76 73 2e 20 | 36 2e 35 25 29 2e 20 20 |.7% vs. |6.5%). |
|000060c0| 53 69 6d 69 6c 61 72 6c | 79 2c 0d 0a 50 43 4f 53 |Similarl|y,..PCOS|
|000060d0| 2d 72 65 6c 61 74 65 64 | 20 73 79 6d 70 74 6f 6d |-related| symptom|
|000060e0| 73 20 77 65 72 65 20 73 | 69 67 6e 69 66 69 63 61 |s were s|ignifica|
|000060f0| 6e 74 6c 79 20 6d 6f 72 | 65 20 66 72 65 71 75 65 |ntly mor|e freque|
|00006100| 6e 74 20 69 6e 20 66 65 | 6d 61 6c 65 20 66 69 72 |nt in fe|male fir|
|00006110| 73 74 2d 64 65 67 72 65 | 65 0d 0a 72 65 6c 61 74 |st-degre|e..relat|
|00006120| 69 76 65 73 20 6f 66 20 | 70 61 74 69 65 6e 74 73 |ives of |patients|
|00006130| 20 77 69 74 68 20 50 43 | 4f 53 20 74 68 61 6e 20 | with PC|OS than |
|00006140| 63 6f 6e 74 72 6f 6c 73 | 20 28 33 31 2e 34 25 20 |controls| (31.4% |
|00006150| 76 73 2e 20 33 2e 32 25 | 29 2e 20 20 53 69 6d 69 |vs. 3.2%|). Simi|
|00006160| 6c 61 72 0d 0a 61 73 73 | 6f 63 69 61 74 69 6f 6e |lar..ass|ociation|
|00006170| 73 20 77 65 72 65 20 6f | 62 73 65 72 76 65 64 20 |s were o|bserved |
|00006180| 69 6e 20 73 65 63 6f 6e | 64 2d 64 65 67 72 65 65 |in secon|d-degree|
|00006190| 20 72 65 6c 61 74 69 76 | 65 73 2c 20 62 75 74 20 | relativ|es, but |
|000061a0| 74 68 65 20 64 61 74 61 | 20 77 65 72 65 0d 0a 69 |the data| were..i|
|000061b0| 6e 61 64 65 71 75 61 74 | 65 2e 20 20 54 68 65 72 |nadequat|e. Ther|
|000061c0| 65 20 77 61 73 20 61 20 | 74 65 6e 64 65 6e 63 79 |e was a |tendency|
|000061d0| 20 66 6f 72 20 66 61 6d | 69 6c 69 61 6c 20 63 6c | for fam|ilial cl|
|000061e0| 75 73 74 65 72 69 6e 67 | 20 77 68 65 6e 20 74 68 |ustering| when th|
|000061f0| 65 20 70 72 6f 62 61 6e | 64 20 77 61 73 0d 0a 68 |e proban|d was..h|
|00006200| 69 72 73 75 74 65 2c 20 | 77 68 65 72 65 61 73 20 |irsute, |whereas |
|00006210| 6e 6f 20 63 6c 75 73 74 | 65 72 69 6e 67 20 77 61 |no clust|ering wa|
|00006220| 73 20 6f 62 73 65 72 76 | 65 64 20 77 68 65 6e 20 |s observ|ed when |
|00006230| 74 68 65 20 70 72 6f 62 | 61 6e 64 20 68 61 64 20 |the prob|and had |
|00006240| 70 72 69 6d 61 72 79 0d | 0a 61 6d 65 6e 6f 72 72 |primary.|.amenorr|
|00006250| 68 65 61 2e 20 20 4f 76 | 65 72 61 6c 6c 2c 20 66 |hea. Ov|erall, f|
|00006260| 65 72 74 69 6c 69 74 79 | 20 77 61 73 20 6e 6f 74 |ertility| was not|
|00006270| 20 72 65 64 75 63 65 64 | 20 69 6e 20 74 68 65 73 | reduced| in thes|
|00006280| 65 20 66 61 6d 69 6c 69 | 65 73 2e 20 20 49 6e 20 |e famili|es. In |
|00006290| 61 0d 0a 73 75 62 67 72 | 6f 75 70 20 6f 66 20 35 |a..subgr|oup of 5|
|000062a0| 32 20 66 61 6d 69 6c 69 | 65 73 20 6f 66 20 70 61 |2 famili|es of pa|
|000062b0| 74 69 65 6e 74 73 20 77 | 69 74 68 20 50 43 4f 53 |tients w|ith PCOS|
|000062c0| 20 77 69 74 68 20 31 20 | 61 66 66 65 63 74 65 64 | with 1 |affected|
|000062d0| 20 70 61 72 65 6e 74 2c | 20 33 35 25 20 6f 66 0d | parent,| 35% of.|
|000062e0| 0a 62 72 6f 74 68 65 72 | 73 20 61 6e 64 20 35 38 |.brother|s and 58|
|000062f0| 25 20 6f 66 20 73 69 73 | 74 65 72 73 20 68 61 64 |% of sis|ters had|
|00006300| 20 73 79 6d 70 74 6f 6d | 73 2e 0d 0a 20 20 20 20 | symptom|s... |
|00006310| 20 54 68 65 72 65 20 69 | 73 20 61 20 73 69 67 6e | There i|s a sign|
|00006320| 69 66 69 63 61 6e 74 6c | 79 20 68 69 67 68 65 72 |ificantl|y higher|
|00006330| 20 70 72 6f 70 6f 72 74 | 69 6f 6e 20 6f 66 20 72 | proport|ion of r|
|00006340| 65 6c 61 74 69 76 65 73 | 20 6f 66 20 70 61 74 69 |elatives| of pati|
|00006350| 65 6e 74 73 20 77 69 74 | 68 0d 0a 50 43 4f 53 20 |ents wit|h..PCOS |
|00006360| 77 68 6f 20 68 61 76 65 | 20 50 43 4f 53 2d 72 65 |who have| PCOS-re|
|00006370| 6c 61 74 65 64 20 73 69 | 67 6e 73 20 61 6e 64 20 |lated si|gns and |
|00006380| 73 79 6d 70 74 6f 6d 73 | 2e 20 20 41 73 20 61 20 |symptoms|. As a |
|00006390| 67 72 6f 75 70 2c 20 61 | 75 74 6f 73 6f 6d 61 6c |group, a|utosomal|
|000063a0| 20 64 6f 6d 69 6e 61 6e | 74 0d 0a 69 6e 68 65 72 | dominan|t..inher|
|000063b0| 69 74 61 6e 63 65 20 63 | 6f 75 6c 64 20 62 65 20 |itance c|ould be |
|000063c0| 65 78 63 6c 75 64 65 64 | 20 61 73 20 61 6e 20 65 |excluded| as an e|
|000063d0| 78 70 6c 61 6e 61 74 69 | 6f 6e 20 66 6f 72 20 74 |xplanati|on for t|
|000063e0| 68 65 20 50 43 4f 53 2e | 20 20 48 6f 77 65 76 65 |he PCOS.| Howeve|
|000063f0| 72 2c 20 74 68 65 0d 0a | 69 6e 63 72 65 61 73 65 |r, the..|increase|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.
