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|000004a0| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 38 |$Unique_|ID{YRB08|
|000004b0| 34 30 30 7d 0d 0a 24 54 | 69 74 6c 65 7b 50 75 6c |400}..$T|itle{Pul|
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|000004d0| 20 6f 66 20 48 75 6d 61 | 6e 20 43 68 6f 72 69 6f | of Huma|n Chorio|
|000004e0| 6e 69 63 20 47 6f 6e 61 | 64 6f 74 72 6f 70 69 6e |nic Gona|dotropin|
|000004f0| 20 69 6e 20 4e 6f 72 6d | 61 6c 20 41 64 75 6c 74 | in Norm|al Adult|
|00000500| 73 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 0d 0a 4f 64 |s}..$Aut|hor{..Od|
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|00000530| 6e 7b 55 6e 69 76 20 6f | 66 20 55 74 61 68 2c 20 |n{Univ o|f Utah, |
|00000540| 53 61 6c 74 20 4c 61 6b | 65 20 43 69 74 79 7d 0d |Salt Lak|e City}.|
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|00000580| 20 73 65 63 72 65 74 69 | 6f 6e 20 6f 66 7d 0d 0a | secreti|on of}..|
|00000590| 24 4a 6f 75 72 6e 61 6c | 7b 4e 20 45 6e 67 6c 20 |$Journal|{N Engl |
|000005a0| 4a 20 4d 65 64 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |J Med}..|$Volume{|
|000005b0| 33 31 37 7d 0d 0a 24 50 | 61 67 65 7b 31 36 38 38 |317}..$P|age{1688|
|000005c0| 2d 31 36 39 31 7d 0d 0a | 24 44 61 74 65 7b 44 65 |-1691}..|$Date{De|
|000005d0| 63 20 33 31 2c 20 31 39 | 38 37 7d 0d 0a 24 59 42 |c 31, 19|87}..$YB|
|000005e0| 56 6f 6c 7b 31 39 38 39 | 20 59 65 61 72 20 42 6f |Vol{1989| Year Bo|
|000005f0| 6f 6b 20 6f 66 20 45 6e | 64 6f 63 72 69 6e 6f 6c |ok of En|docrinol|
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|00000610| 2d 31 34 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |-14}..$Y|BEditor{|
|00000620| 44 72 73 2e 20 42 61 67 | 64 61 64 65 2c 20 42 72 |Drs. Bag|dade, Br|
|00000630| 61 76 65 72 6d 61 6e 2c | 20 48 61 6c 74 65 72 2c |averman,| Halter,|
|00000640| 20 48 6f 72 74 6f 6e 2c | 20 4b 6f 72 65 6e 6d 61 | Horton,| Korenma|
|00000650| 6e 2c 20 4b 6f 72 6e 65 | 6c 2c 20 4d 65 74 7a 2c |n, Korne|l, Metz,|
|00000660| 20 4d 6f 6c 69 74 63 68 | 2c 20 4d 6f 72 6c 65 79 | Molitch|, Morley|
|00000670| 2c 20 52 6f 67 6f 6c 2c | 20 52 79 61 6e 2c 20 53 |, Rogol,| Ryan, S|
|00000680| 68 65 72 77 69 6e 2c 20 | 61 6e 64 20 56 61 69 74 |herwin, |and Vait|
|00000690| 75 6b 61 69 74 69 73 7d | 0d 0a 24 54 61 62 6c 65 |ukaitis}|..$Table|
|000006a0| 7b 54 61 62 6c 65 20 4f | 6d 69 74 74 65 64 7d 0d |{Table O|mitted}.|
|000006b0| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 4d 2e |.$Commen|tator{M.|
|000006c0| 45 2e 20 4d 6f 6c 69 74 | 63 68 2c 20 4d 2e 44 2e |E. Molit|ch, M.D.|
|000006d0| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|000006e0| 63 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |c) Year |Book Med|
|000006f0| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00000700| 20 49 6e 63 2e 2c 20 31 | 39 38 39 0d 0a 0d 0a 31 | Inc., 1|989....1|
|00000710| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|00000720| 20 45 6e 64 6f 63 72 69 | 6e 6f 6c 6f 67 79 20 28 | Endocri|nology (|
|00000730| 52 29 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 31 2d |R)....Ch|apter 1-|
|00000740| 2d 4e 65 75 72 6f 65 6e | 64 6f 63 72 69 6e 6f 6c |-Neuroen|docrinol|
|00000750| 6f 67 79 0d 0a 0d 0a 54 | 68 65 20 41 6e 74 65 72 |ogy....T|he Anter|
|00000760| 69 6f 72 20 50 69 74 75 | 69 74 61 72 79 20 47 6c |ior Pitu|itary Gl|
|00000770| 61 6e 64 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |and....-|--------|
|00000780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007c0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 50 75 6c 73 61 74 69 |-------.|.Pulsati|
|000007d0| 6c 65 20 53 65 63 72 65 | 74 69 6f 6e 20 6f 66 20 |le Secre|tion of |
|000007e0| 48 75 6d 61 6e 20 43 68 | 6f 72 69 6f 6e 69 63 20 |Human Ch|orionic |
|000007f0| 47 6f 6e 61 64 6f 74 72 | 6f 70 69 6e 20 69 6e 20 |Gonadotr|opin in |
|00000800| 4e 6f 72 6d 61 6c 20 41 | 64 75 6c 74 73 0d 0a 0d |Normal A|dults...|
|00000810| 0a 4f 64 65 6c 6c 20 57 | 44 2c 20 47 72 69 66 66 |.Odell W|D, Griff|
|00000820| 69 6e 20 4a 0d 0a 28 55 | 6e 69 76 20 6f 66 20 55 |in J..(U|niv of U|
|00000830| 74 61 68 2c 20 53 61 6c | 74 20 4c 61 6b 65 20 43 |tah, Sal|t Lake C|
|00000840| 69 74 79 29 0d 0a 4e 20 | 45 6e 67 6c 20 4a 20 4d |ity)..N |Engl J M|
|00000850| 65 64 20 33 31 37 3a 31 | 36 38 38 2d 31 36 39 31 |ed 317:1|688-1691|
|00000860| 2c 20 44 65 63 20 33 31 | 2c 20 31 39 38 37 0d 0a |, Dec 31|, 1987..|
|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 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008c0| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|000008d0| 20 20 20 20 20 48 75 6d | 61 6e 20 63 68 6f 72 69 |     Hum|an chori|
|000008e0| 6f 6e 69 63 20 67 6f 6e | 61 64 6f 74 72 6f 70 69 |onic gon|adotropi|
|000008f0| 6e 20 28 68 43 47 29 20 | 69 73 20 70 72 65 73 65 |n (hCG) |is prese|
|00000900| 6e 74 20 69 6e 20 74 68 | 65 20 6e 6f 72 6d 61 6c |nt in th|e normal|
|00000910| 20 70 69 74 75 69 74 61 | 72 79 20 6f 66 0d 0a 68 | pituita|ry of..h|
|00000920| 75 6d 61 6e 73 2c 20 75 | 72 69 6e 65 20 66 72 6f |umans, u|rine fro|
|00000930| 6d 20 68 75 6d 61 6e 73 | 2c 20 61 6e 64 20 74 68 |m humans|, and th|
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|00000950| 20 6f 66 20 6c 61 72 67 | 65 20 76 6f 6c 75 6d 65 | of larg|e volume|
|00000960| 73 20 6f 66 20 73 65 72 | 75 6d 20 66 72 6f 6d 0d |s of ser|um from.|
|00000970| 0a 6e 6f 72 6d 61 6c 20 | 68 75 6d 61 6e 73 2e 20 |.normal |humans. |
|00000980| 20 54 6f 20 66 75 72 74 | 68 65 72 20 63 68 61 72 | To furt|her char|
|00000990| 61 63 74 65 72 69 7a 65 | 20 74 68 65 20 70 72 6f |acterize| the pro|
|000009a0| 64 75 63 74 69 6f 6e 20 | 6f 66 20 68 43 47 20 69 |duction |of hCG i|
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|000009c0| 0d 0a 68 43 47 20 61 6e | 64 20 68 75 6d 61 6e 20 |..hCG an|d human |
|000009d0| 4c 48 20 28 68 4c 48 29 | 20 77 65 72 65 20 6d 65 |LH (hLH)| were me|
|000009e0| 61 73 75 72 65 64 20 69 | 6e 20 73 65 72 75 6d 20 |asured i|n serum |
|000009f0| 73 61 6d 70 6c 65 73 20 | 6f 62 74 61 69 6e 65 64 |samples |obtained|
|00000a00| 20 66 72 6f 6d 20 6e 6f | 72 6d 61 6c 20 6d 65 6e | from no|rmal men|
|00000a10| 0d 0a 61 6e 64 20 6e 6f | 72 6d 61 6c 20 70 72 65 |..and no|rmal pre|
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|00000a60| 63 0d 0a 6d 6f 6e 6f 63 | 6c 6f 6e 61 6c 2d 61 6e |c..monoc|lonal-an|
|00000a70| 74 69 62 6f 64 79 20 73 | 61 6e 64 77 69 63 68 20 |tibody s|andwich |
|00000a80| 61 73 73 61 79 73 20 74 | 68 61 74 20 65 6d 70 6c |assays t|hat empl|
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|00000ab0| 0d 0a 73 65 70 61 72 61 | 74 69 6f 6e 20 6d 65 74 |..separa|tion met|
|00000ac0| 68 6f 64 2e 0d 0a 20 20 | 20 20 20 48 75 6d 61 6e |hod...  |   Human|
|00000ad0| 20 63 68 6f 72 69 6f 6e | 69 63 20 67 6f 6e 61 64 | chorion|ic gonad|
|00000ae0| 6f 74 72 6f 70 69 6e 20 | 77 61 73 20 64 65 74 65 |otropin |was dete|
|00000af0| 63 74 61 62 6c 65 20 69 | 6e 20 37 33 25 20 6f 66 |ctable i|n 73% of|
|00000b00| 20 39 32 20 6d 65 6e 20 | 61 67 65 64 20 32 35 2d | 92 men |aged 25-|
|00000b10| 37 30 0d 0a 79 65 61 72 | 73 20 77 68 65 6e 20 73 |70..year|s when s|
|00000b20| 69 6e 67 6c 65 20 73 65 | 72 75 6d 20 73 61 6d 70 |ingle se|rum samp|
|00000b30| 6c 65 73 20 77 65 72 65 | 20 75 73 65 64 20 61 6e |les were| used an|
|00000b40| 64 20 64 65 74 65 63 74 | 61 62 6c 65 20 69 6e 20 |d detect|able in |
|00000b50| 61 6c 6c 20 6d 65 6e 20 | 77 68 65 6e 0d 0a 6d 75 |all men |when..mu|
|00000b60| 6c 74 69 70 6c 65 20 73 | 65 72 75 6d 20 73 61 6d |ltiple s|erum sam|
|00000b70| 70 6c 65 73 20 77 65 72 | 65 20 75 73 65 64 2e 20 |ples wer|e used. |
|00000b80| 20 49 6e 20 6e 6f 72 6d | 61 6c 20 6d 65 6e 20 74 | In norm|al men t|
|00000b90| 68 65 20 61 6d 6f 75 6e | 74 20 6f 66 20 64 65 74 |he amoun|t of det|
|00000ba0| 65 63 74 61 62 6c 65 20 | 68 43 47 0d 0a 61 76 65 |ectable |hCG..ave|
|00000bb0| 72 61 67 65 64 20 38 2e | 39 20 70 67 2f 6d 6c 2c |raged 8.|9 pg/ml,|
|00000bc0| 20 77 69 74 68 20 61 20 | 72 61 6e 67 65 20 6f 66 | with a |range of|
|00000bd0| 20 6c 65 73 73 20 74 68 | 61 6e 20 33 20 70 67 2f | less th|an 3 pg/|
|00000be0| 6d 6c 20 74 6f 20 31 36 | 30 20 70 67 2f 6d 6c 20 |ml to 16|0 pg/ml |
|00000bf0| 28 62 69 6f 6c 6f 67 69 | 63 0d 0a 70 6f 74 65 6e |(biologi|c..poten|
|00000c00| 63 79 20 3d 20 31 33 2c | 34 35 30 20 49 55 2f 6d |cy = 13,|450 IU/m|
|00000c10| 67 29 2e 20 20 49 6e 20 | 70 6f 73 74 6d 65 6e 6f |g).  In |postmeno|
|00000c20| 70 61 75 73 61 6c 20 77 | 6f 6d 65 6e 20 74 68 65 |pausal w|omen the|
|00000c30| 20 68 43 47 20 6c 65 76 | 65 6c 20 61 76 65 72 61 | hCG lev|el avera|
|00000c40| 67 65 64 20 31 31 31 0d | 0a 70 67 2f 6d 6c 2c 20 |ged 111.|.pg/ml, |
|00000c50| 72 61 6e 67 69 6e 67 20 | 66 72 6f 6d 20 33 32 20 |ranging |from 32 |
|00000c60| 70 67 2f 6d 6c 20 74 6f | 20 35 31 30 20 70 67 2f |pg/ml to| 510 pg/|
|00000c70| 6d 6c 2e 20 20 49 6e 20 | 77 6f 6d 65 6e 20 6f 66 |ml.  In |women of|
|00000c80| 20 72 65 70 72 6f 64 75 | 63 74 69 76 65 20 61 67 | reprodu|ctive ag|
|00000c90| 65 20 74 68 65 20 68 43 | 47 0d 0a 6c 65 76 65 6c |e the hC|G..level|
|00000ca0| 20 76 61 72 69 65 64 20 | 77 69 74 68 20 74 68 65 | varied |with the|
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|00000cc0| 2e 20 20 54 68 65 20 64 | 61 69 6c 79 20 68 43 47 |.  The d|aily hCG|
|00000cd0| 20 6c 65 76 65 6c 73 20 | 74 68 72 6f 75 67 68 6f | levels |througho|
|00000ce0| 75 74 20 61 20 6e 6f 72 | 6d 61 6c 0d 0a 6d 65 6e |ut a nor|mal..men|
|00000cf0| 73 74 72 75 61 6c 20 63 | 79 63 6c 65 20 70 61 72 |strual c|ycle par|
|00000d00| 61 6c 6c 65 6c 65 64 20 | 74 68 6f 73 65 20 6f 66 |alleled |those of|
|00000d10| 20 68 4c 48 3b 20 66 6f | 6c 6c 69 63 75 6c 61 72 | hLH; fo|llicular|
|00000d20| 2d 70 68 61 73 65 20 63 | 6f 6e 63 65 6e 74 72 61 |-phase c|oncentra|
|00000d30| 74 69 6f 6e 73 20 77 65 | 72 65 0d 0a 68 69 67 68 |tions we|re..high|
|00000d40| 65 72 20 74 68 61 6e 20 | 74 68 6f 73 65 20 6f 66 |er than |those of|
|00000d50| 20 74 68 65 20 6c 75 74 | 65 61 6c 20 70 68 61 73 | the lut|eal phas|
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|00001b60| 6e 69 74 61 6c 20 6e 65 | 70 68 72 6f 67 65 6e 69 |nital ne|phrogeni|
|00001b70| 63 2c 20 64 44 41 56 50 | 20 69 6e 3b 0d 0a 64 44 |c, dDAVP| in;..dD|
|00001b80| 41 56 50 20 69 6e 20 64 | 69 61 62 65 74 65 73 20 |AVP in d|iabetes |
|00001b90| 69 6e 73 69 70 69 64 75 | 73 2c 20 63 6f 6e 67 65 |insipidu|s, conge|
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|00001bb0| 63 3b 0d 0a 43 6f 61 67 | 75 6c 61 74 69 6f 6e 20 |c;..Coag|ulation |
|00001bc0| 72 65 73 70 6f 6e 73 65 | 73 20 74 6f 20 64 44 41 |response|s to dDA|
|00001bd0| 56 50 20 69 6e 20 63 6f | 6e 67 65 6e 69 74 61 6c |VP in co|ngenital|
|00001be0| 20 6e 65 70 68 72 6f 67 | 65 6e 69 63 20 64 69 61 | nephrog|enic dia|
|00001bf0| 62 65 74 65 73 20 69 6e | 73 69 70 69 64 75 73 7d |betes in|sipidus}|
|00001c00| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 4e 20 45 6e 67 |..$Journ|al{N Eng|
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|00001c20| 65 7b 33 31 38 7d 0d 0a | 24 50 61 67 65 7b 38 38 |e{318}..|$Page{88|
|00001c30| 31 2d 38 38 37 7d 0d 0a | 24 44 61 74 65 7b 41 70 |1-887}..|$Date{Ap|
|00001c40| 72 20 37 2c 20 31 39 38 | 38 7d 0d 0a 24 59 42 56 |r 7, 198|8}..$YBV|
|00001c50| 6f 6c 7b 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |ol{1989 |Year Boo|
|00001c60| 6b 20 6f 66 20 45 6e 64 | 6f 63 72 69 6e 6f 6c 6f |k of End|ocrinolo|
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|00001c80| 32 30 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |20}..$YB|Editor{D|
|00001c90| 72 73 2e 20 42 61 67 64 | 61 64 65 2c 20 42 72 61 |rs. Bagd|ade, Bra|
|00001ca0| 76 65 72 6d 61 6e 2c 20 | 48 61 6c 74 65 72 2c 20 |verman, |Halter, |
|00001cb0| 48 6f 72 74 6f 6e 2c 20 | 4b 6f 72 65 6e 6d 61 6e |Horton, |Korenman|
|00001cc0| 2c 20 4b 6f 72 6e 65 6c | 2c 20 4d 65 74 7a 2c 20 |, Kornel|, Metz, |
|00001cd0| 4d 6f 6c 69 74 63 68 2c | 20 4d 6f 72 6c 65 79 2c |Molitch,| Morley,|
|00001ce0| 20 52 6f 67 6f 6c 2c 20 | 52 79 61 6e 2c 20 53 68 | Rogol, |Ryan, Sh|
|00001cf0| 65 72 77 69 6e 2c 20 61 | 6e 64 20 56 61 69 74 75 |erwin, a|nd Vaitu|
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|00001d20| 4d 2e 45 2e 20 4d 6f 6c | 69 74 63 68 2c 20 4d 2e |M.E. Mol|itch, M.|
|00001d30| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|00001d40| 20 28 63 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (c) Yea|r Book M|
|00001d50| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00001d60| 73 2c 20 49 6e 63 2e 2c | 20 31 39 38 39 0d 0a 0d |s, Inc.,| 1989...|
|00001d70| 0a 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1989 Ye|ar Book |
|00001d80| 6f 66 20 45 6e 64 6f 63 | 72 69 6e 6f 6c 6f 67 79 |of Endoc|rinology|
|00001d90| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|00001da0| 31 2d 2d 4e 65 75 72 6f | 65 6e 64 6f 63 72 69 6e |1--Neuro|endocrin|
|00001db0| 6f 6c 6f 67 79 0d 0a 0d | 0a 54 68 65 20 50 6f 73 |ology...|.The Pos|
|00001dc0| 74 65 72 69 6f 72 20 50 | 69 74 75 69 74 61 72 79 |terior P|ituitary|
|00001dd0| 20 47 6c 61 6e 64 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d | Gland..|..------|
|00001de0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001df0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 48 65 6d 6f |--------|--..Hemo|
|00001e30| 64 79 6e 61 6d 69 63 20 | 61 6e 64 20 43 6f 61 67 |dynamic |and Coag|
|00001e40| 75 6c 61 74 69 6f 6e 20 | 52 65 73 70 6f 6e 73 65 |ulation |Response|
|00001e50| 73 20 74 6f 20 31 2d 44 | 65 73 61 6d 69 6e 6f 20 |s to 1-D|esamino |
|00001e60| 5b 38 2d 44 2d 41 72 67 | 69 6e 69 6e 65 5d 20 56 |[8-D-Arg|inine] V|
|00001e70| 61 73 6f 70 72 65 73 73 | 69 6e 0d 0a 69 6e 20 50 |asopress|in..in P|
|00001e80| 61 74 69 65 6e 74 73 20 | 57 69 74 68 20 43 6f 6e |atients |With Con|
|00001e90| 67 65 6e 69 74 61 6c 20 | 4e 65 70 68 72 6f 67 65 |genital |Nephroge|
|00001ea0| 6e 69 63 20 44 69 61 62 | 65 74 65 73 20 49 6e 73 |nic Diab|etes Ins|
|00001eb0| 69 70 69 64 75 73 0d 0a | 0d 0a 42 69 63 68 65 74 |ipidus..|..Bichet|
|00001ec0| 20 44 47 2c 20 52 61 7a | 69 20 4d 2c 20 4c 6f 6e | DG, Raz|i M, Lon|
|00001ed0| 65 72 67 61 6e 20 4d 2c | 20 41 72 74 68 75 73 20 |ergan M,| Arthus |
|00001ee0| 4d 2d 46 2c 20 50 61 70 | 75 6b 6e 61 20 56 2c 20 |M-F, Pap|ukna V, |
|00001ef0| 4b 6f 72 74 61 73 20 43 | 2c 20 42 61 72 6a 6f 6e |Kortas C|, Barjon|
|00001f00| 20 4a 2d 4e 0d 0a 28 48 | 6f 70 20 64 75 20 53 61 | J-N..(H|op du Sa|
|00001f10| 63 72 65 2d 43 6f 65 75 | 72 20 64 65 20 4d 6f 6e |cre-Coeu|r de Mon|
|00001f20| 74 72 65 61 6c 20 61 6e | 64 20 4d 6f 6e 74 72 65 |treal an|d Montre|
|00001f30| 61 6c 20 55 6e 69 76 29 | 0d 0a 4e 20 45 6e 67 6c |al Univ)|..N Engl|
|00001f40| 20 4a 20 4d 65 64 20 33 | 31 38 3a 38 38 31 2d 38 | J Med 3|18:881-8|
|00001f50| 38 37 2c 20 41 70 72 20 | 37 2c 20 31 39 38 38 0d |87, Apr |7, 1988.|
|00001f60| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00001f70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001fa0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001fb0| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00001fc0| 0a 20 20 20 20 20 43 6f | 6e 67 65 6e 69 74 61 6c |.     Co|ngenital|
|00001fd0| 20 6e 65 70 68 72 6f 67 | 65 6e 69 63 20 64 69 61 | nephrog|enic dia|
|00001fe0| 62 65 74 65 73 20 69 6e | 73 69 70 69 64 75 73 20 |betes in|sipidus |
|00001ff0| 69 73 20 61 20 72 61 72 | 65 20 58 2d 6c 69 6e 6b |is a rar|e X-link|
|00002000| 65 64 20 64 69 73 6f 72 | 64 65 72 2e 20 20 49 74 |ed disor|der.  It|
|00002010| 0d 0a 69 73 20 61 73 73 | 6f 63 69 61 74 65 64 20 |..is ass|ociated |
|00002020| 77 69 74 68 20 72 65 6e | 61 6c 20 74 75 62 75 6c |with ren|al tubul|
|00002030| 61 72 20 72 65 73 69 73 | 74 61 6e 63 65 20 74 6f |ar resis|tance to|
|00002040| 20 61 72 67 69 6e 69 6e | 65 20 76 61 73 6f 70 72 | arginin|e vasopr|
|00002050| 65 73 73 69 6e 2c 20 74 | 68 65 0d 0a 61 6e 74 69 |essin, t|he..anti|
|00002060| 64 69 75 72 65 74 69 63 | 20 68 6f 72 6d 6f 6e 65 |diuretic| hormone|
|00002070| 2e 20 20 54 68 65 20 61 | 6e 74 69 64 69 75 72 65 |.  The a|ntidiure|
|00002080| 74 69 63 20 61 63 74 69 | 6f 6e 20 6f 66 20 61 72 |tic acti|on of ar|
|00002090| 67 69 6e 69 6e 65 20 76 | 61 73 6f 70 72 65 73 73 |ginine v|asopress|
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|000028e0| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|000028f0| 0d 0a 0d 0a 20 20 20 20 | 20 50 72 65 76 69 6f 75 |....    | Previou|
|00002900| 73 6c 79 20 28 31 39 38 | 37 20 59 45 41 52 20 42 |sly (198|7 YEAR B|
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|00002930| 61 73 20 6e 6f 74 65 64 | 20 74 68 61 74 20 74 68 |as noted| that th|
|00002940| 65 0d 0a 6c 65 76 65 6c | 73 20 6f 66 20 61 72 67 |e..level|s of arg|
|00002950| 69 6e 69 6e 65 20 76 61 | 73 6f 70 72 65 73 73 69 |inine va|sopressi|
|00002960| 6e 20 28 41 56 50 29 20 | 66 6f 75 6e 64 20 64 75 |n (AVP) |found du|
|00002970| 72 69 6e 67 20 73 74 72 | 65 73 73 20 77 65 72 65 |ring str|ess were|
|00002980| 20 63 61 70 61 62 6c 65 | 20 6f 66 0d 0a 73 74 69 | capable| of..sti|
|00002990| 6d 75 6c 61 74 69 6e 67 | 20 61 20 72 69 73 65 20 |mulating| a rise |
|000029a0| 69 6e 20 66 61 63 74 6f | 72 20 56 49 49 49 63 20 |in facto|r VIIIc |
|000029b0| 6c 65 76 65 6c 73 2e 20 | 20 49 6e 20 74 68 69 73 |levels. | In this|
|000029c0| 20 70 61 70 65 72 2c 20 | 77 65 20 66 69 6e 64 20 | paper, |we find |
|000029d0| 74 68 61 74 20 64 44 41 | 56 50 2c 20 61 0d 0a 73 |that dDA|VP, a..s|
|000029e0| 65 6c 65 63 74 69 76 65 | 20 73 74 69 6d 75 6c 61 |elective| stimula|
|000029f0| 74 6f 72 20 6f 66 20 56 | 32 20 72 65 63 65 70 74 |tor of V|2 recept|
|00002a00| 6f 72 73 2c 20 77 61 73 | 20 6e 6f 74 20 61 62 6c |ors, was| not abl|
|00002a10| 65 20 74 6f 20 73 74 69 | 6d 75 6c 61 74 65 20 72 |e to sti|mulate r|
|00002a20| 69 73 65 73 20 69 6e 20 | 74 68 65 0d 0a 6c 65 76 |ises in |the..lev|
|00002a30| 65 6c 73 20 6f 66 20 66 | 61 63 74 6f 72 20 56 49 |els of f|actor VI|
|00002a40| 49 49 63 20 6f 72 20 76 | 6f 6e 20 57 69 6c 6c 65 |IIc or v|on Wille|
|00002a50| 62 72 61 6e 64 20 66 61 | 63 74 6f 72 20 69 6e 20 |brand fa|ctor in |
|00002a60| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 63 6f |patients| with co|
|00002a70| 6e 67 65 6e 69 74 61 6c | 0d 0a 6e 65 70 68 72 6f |ngenital|..nephro|
|00002a80| 67 65 6e 69 63 20 64 69 | 61 62 65 74 65 73 20 69 |genic di|abetes i|
|00002a90| 6e 73 69 70 69 64 75 73 | 2e 20 20 54 68 75 73 2c |nsipidus|.  Thus,|
|00002aa0| 20 69 6e 20 74 68 69 73 | 20 67 72 6f 75 70 2c 20 | in this| group, |
|00002ab0| 74 68 65 20 64 65 66 65 | 63 74 20 69 6e 20 74 68 |the defe|ct in th|
|00002ac0| 65 20 56 32 0d 0a 72 65 | 63 65 70 74 6f 72 20 69 |e V2..re|ceptor i|
|00002ad0| 73 20 67 65 6e 65 72 61 | 6c 69 7a 65 64 20 74 6f |s genera|lized to|
|00002ae0| 20 61 6c 6c 20 74 69 73 | 73 75 65 73 2e 20 20 46 | all tis|sues.  F|
|00002af0| 75 72 74 68 65 72 6d 6f | 72 65 2c 20 74 68 69 73 |urthermo|re, this|
|00002b00| 20 73 74 75 64 79 20 61 | 6c 73 6f 20 73 75 67 67 | study a|lso sugg|
|00002b10| 65 73 74 73 0d 0a 74 68 | 65 20 70 72 65 73 65 6e |ests..th|e presen|
|00002b20| 63 65 20 6f 66 20 56 32 | 20 72 65 63 65 70 74 6f |ce of V2| recepto|
|00002b30| 72 73 20 69 6e 20 74 68 | 65 20 76 61 73 63 75 6c |rs in th|e vascul|
|00002b40| 61 74 75 72 65 20 74 68 | 61 74 20 6d 65 64 69 61 |ature th|at media|
|00002b50| 74 65 20 76 61 73 6f 64 | 69 6c 61 74 61 74 69 6f |te vasod|ilatatio|
|00002b60| 6e 2c 20 61 6e 64 0d 0a | 74 68 61 74 20 64 44 41 |n, and..|that dDA|
|00002b70| 56 50 20 63 61 75 73 65 | 73 20 61 20 66 61 6c 6c |VP cause|s a fall|
|00002b80| 20 69 6e 20 62 6c 6f 6f | 64 20 70 72 65 73 73 75 | in bloo|d pressu|
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|00002ba0| 67 20 74 68 65 73 65 20 | 72 65 63 65 70 74 6f 72 |g these |receptor|
|00002bb0| 73 20 61 6e 64 0d 0a 6e | 6f 74 20 62 79 20 61 6e |s and..n|ot by an|
|00002bc0| 74 61 67 6f 6e 69 7a 69 | 6e 67 20 74 68 65 20 65 |tagonizi|ng the e|
|00002bd0| 66 66 65 63 74 20 6f 66 | 20 65 6e 64 6f 67 65 6e |ffect of| endogen|
|00002be0| 6f 75 73 20 41 56 50 20 | 61 74 20 56 31 20 72 65 |ous AVP |at V1 re|
|00002bf0| 63 65 70 74 6f 72 73 2e | 20 20 53 69 6d 69 6c 61 |ceptors.|  Simila|
|00002c00| 72 0d 0a 66 69 6e 64 69 | 6e 67 73 20 77 65 72 65 |r..findi|ngs were|
|00002c10| 20 72 65 70 6f 72 74 65 | 64 20 69 6e 20 32 20 70 | reporte|d in 2 p|
|00002c20| 61 74 69 65 6e 74 73 20 | 62 79 20 4b 6f 72 62 69 |atients |by Korbi|
|00002c30| 6e 73 6b 69 20 65 74 20 | 61 6c 2e 20 28 4c 61 6e |nski et |al. (Lan|
|00002c40| 63 65 74 20 31 3a 31 32 | 39 33 2c 20 31 39 38 35 |cet 1:12|93, 1985|
|00002c50| 29 2e 0d 0a 48 6f 77 65 | 76 65 72 2c 20 61 6c 6c |)...Howe|ver, all|
|00002c60| 20 69 73 20 6e 6f 74 20 | 63 6c 61 72 69 66 69 65 | is not |clarifie|
|00002c70| 64 20 62 79 20 74 68 65 | 73 65 20 73 74 75 64 69 |d by the|se studi|
|00002c80| 65 73 2e 20 20 4d 6f 73 | 65 73 20 65 74 20 61 6c |es.  Mos|es et al|
|00002c90| 2e 20 28 4a 20 43 6c 69 | 6e 20 45 6e 64 6f 63 72 |. (J Cli|n Endocr|
|00002ca0| 69 6e 6f 6c 0d 0a 4d 65 | 74 61 62 20 36 36 3a 31 |inol..Me|tab 66:1|
|00002cb0| 32 35 39 2c 20 31 39 38 | 38 29 20 70 65 72 66 6f |259, 198|8) perfo|
|00002cc0| 72 6d 65 64 20 73 74 75 | 64 69 65 73 20 69 6e 20 |rmed stu|dies in |
|00002cd0| 32 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |2 patien|ts with |
|00002ce0| 63 6f 6e 67 65 6e 69 74 | 61 6c 20 6e 65 70 68 72 |congenit|al nephr|
|00002cf0| 6f 67 65 6e 69 63 0d 0a | 64 69 61 62 65 74 65 73 |ogenic..|diabetes|
|00002d00| 20 69 6e 73 69 70 69 64 | 75 73 2c 20 6f 62 73 65 | insipid|us, obse|
|00002d10| 72 76 69 6e 67 20 73 69 | 6d 69 6c 61 72 20 72 65 |rving si|milar re|
|00002d20| 73 75 6c 74 73 20 69 6e | 20 31 20 62 75 74 20 6e |sults in| 1 but n|
|00002d30| 6f 72 6d 61 6c 20 68 65 | 6d 6f 73 74 61 74 69 63 |ormal he|mostatic|
|00002d40| 0d 0a 66 69 6e 64 69 6e | 67 73 20 69 6e 20 74 68 |..findin|gs in th|
|00002d50| 65 20 6f 74 68 65 72 2e | 20 20 42 72 65 6e 6e 65 |e other.|  Brenne|
|00002d60| 72 20 65 74 20 61 6c 2e | 20 28 4a 20 43 6c 69 6e |r et al.| (J Clin|
|00002d70| 20 45 6e 64 6f 63 72 69 | 6e 6f 6c 20 4d 65 74 61 | Endocri|nol Meta|
|00002d80| 62 20 36 37 3a 31 39 31 | 2c 20 31 39 38 38 29 0d |b 67:191|, 1988).|
|00002d90| 0a 66 6f 75 6e 64 20 6e | 6f 72 6d 61 6c 20 68 65 |.found n|ormal he|
|00002da0| 6d 6f 73 74 61 74 69 63 | 20 72 65 73 70 6f 6e 73 |mostatic| respons|
|00002db0| 65 73 20 74 6f 20 64 44 | 41 56 50 20 69 6e 20 74 |es to dD|AVP in t|
|00002dc0| 68 65 69 72 20 34 20 70 | 61 74 69 65 6e 74 73 20 |heir 4 p|atients |
|00002dd0| 77 69 74 68 20 6e 65 70 | 68 72 6f 67 65 6e 69 63 |with nep|hrogenic|
|00002de0| 0d 0a 64 69 61 62 65 74 | 65 73 20 69 6e 73 69 70 |..diabet|es insip|
|00002df0| 69 64 75 73 2e 20 20 54 | 68 65 72 65 20 61 72 65 |idus.  T|here are|
|00002e00| 20 6f 62 76 69 6f 75 73 | 6c 79 20 6d 61 6e 79 20 | obvious|ly many |
|00002e10| 70 6f 73 73 69 62 69 6c | 69 74 69 65 73 20 74 6f |possibil|ities to|
|00002e20| 20 65 78 70 6c 61 69 6e | 20 74 68 65 73 65 0d 0a | explain| these..|
|00002e30| 64 69 73 63 72 65 70 61 | 6e 63 69 65 73 2c 20 62 |discrepa|ncies, b|
|00002e40| 75 74 20 69 74 20 61 70 | 70 65 61 72 73 20 74 68 |ut it ap|pears th|
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|00002e80| 0a 69 73 20 68 65 74 65 | 72 6f 67 65 6e 65 6f 75 |.is hete|rogeneou|
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|00002ea0| 2c 20 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |, M.D...|$Unique_|
|00002eb0| 49 44 7b 59 52 42 30 38 | 34 30 32 7d 0d 0a 24 54 |ID{YRB08|402}..$T|
|00002ec0| 69 74 6c 65 7b 4c 6f 6e | 67 2d 54 65 72 6d 20 47 |itle{Lon|g-Term G|
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|00002f40| 0a 42 6f 64 65 2c 20 48 | 48 0d 0a 43 72 61 77 66 |.Bode, H|H..Crawf|
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|00002f80| 6f 73 74 6f 6e 3b 20 48 | 61 72 76 61 72 64 20 4d |oston; H|arvard M|
|00002f90| 65 64 20 53 63 68 6f 6f | 6c 7d 0d 0a 24 53 75 62 |ed Schoo|l}..$Sub|
|00002fa0| 6a 65 63 74 7b 48 79 70 | 6f 74 68 79 72 6f 69 64 |ject{Hyp|othyroid|
|00002fb0| 69 73 6d 20 6a 75 76 65 | 6e 69 6c 65 20 61 63 71 |ism juve|nile acq|
|00002fc0| 75 69 72 65 64 2c 20 6c | 6f 6e 67 2d 74 65 72 6d |uired, l|ong-term|
|00002fd0| 20 67 72 6f 77 74 68 20 | 69 6e 3b 0d 0a 43 68 69 | growth |in;..Chi|
|00002fe0| 6c 64 72 65 6e 20 68 79 | 70 6f 74 68 79 72 6f 69 |ldren hy|pothyroi|
|00002ff0| 64 69 73 6d 20 69 6e 2c | 20 61 63 71 75 69 72 65 |dism in,| acquire|
|00003000| 64 2c 20 6c 6f 6e 67 2d | 74 65 72 6d 20 67 72 6f |d, long-|term gro|
|00003010| 77 74 68 20 69 6e 7d 0d | 0a 24 4a 6f 75 72 6e 61 |wth in}.|.$Journa|
|00003020| 6c 7b 4e 20 45 6e 67 6c | 20 4a 20 4d 65 64 7d 0d |l{N Engl| J Med}.|
|00003030| 0a 24 56 6f 6c 75 6d 65 | 7b 33 31 38 7d 0d 0a 24 |.$Volume|{318}..$|
|00003040| 50 61 67 65 7b 35 39 39 | 2d 36 30 32 7d 0d 0a 24 |Page{599|-602}..$|
|00003050| 44 61 74 65 7b 4d 61 72 | 63 68 20 31 30 2c 20 31 |Date{Mar|ch 10, 1|
|00003060| 39 38 38 7d 0d 0a 24 59 | 42 56 6f 6c 7b 31 39 38 |988}..$Y|BVol{198|
|00003070| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 45 |9 Year B|ook of E|
|00003080| 6e 64 6f 63 72 69 6e 6f | 6c 6f 67 79 7d 0d 0a 24 |ndocrino|logy}..$|
|00003090| 43 68 61 70 74 65 72 7b | 32 2d 35 7d 0d 0a 24 59 |Chapter{|2-5}..$Y|
|000030a0| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 42 61 67 |BEditor{|Drs. Bag|
|000030b0| 64 61 64 65 2c 20 42 72 | 61 76 65 72 6d 61 6e 2c |dade, Br|averman,|
|000030c0| 20 48 61 6c 74 65 72 2c | 20 48 6f 72 74 6f 6e 2c | Halter,| Horton,|
|000030d0| 20 4b 6f 72 65 6e 6d 61 | 6e 2c 20 4b 6f 72 6e 65 | Korenma|n, Korne|
|000030e0| 6c 2c 20 4d 65 74 7a 2c | 20 4d 6f 6c 69 74 63 68 |l, Metz,| Molitch|
|000030f0| 2c 20 4d 6f 72 6c 65 79 | 2c 20 52 6f 67 6f 6c 2c |, Morley|, Rogol,|
|00003100| 20 52 79 61 6e 2c 20 53 | 68 65 72 77 69 6e 2c 20 | Ryan, S|herwin, |
|00003110| 61 6e 64 20 56 61 69 74 | 75 6b 61 69 74 69 73 7d |and Vait|ukaitis}|
|00003120| 0d 0a 24 54 61 62 6c 65 | 7b 54 61 62 6c 65 20 4f |..$Table|{Table O|
|00003130| 6d 69 74 74 65 64 7d 0d | 0a 24 43 6f 6d 6d 65 6e |mitted}.|.$Commen|
|00003140| 74 61 74 6f 72 7b 41 2e | 44 2e 20 52 6f 67 6f 6c |tator{A.|D. Rogol|
|00003150| 2c 20 4d 2e 44 2e 2c 20 | 50 68 2e 44 2e 7d 0d 0a |, M.D., |Ph.D.}..|
|00003160| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|00003170| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|00003180| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|00003190| 63 2e 2c 20 31 39 38 39 | 0d 0a 0d 0a 31 39 38 39 |c., 1989|....1989|
|000031a0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 45 6e | Year Bo|ok of En|
|000031b0| 64 6f 63 72 69 6e 6f 6c | 6f 67 79 20 28 52 29 0d |docrinol|ogy (R).|
|000031c0| 0a 0d 0a 43 68 61 70 74 | 65 72 20 32 2d 2d 50 65 |...Chapt|er 2--Pe|
|000031d0| 64 69 61 74 72 69 63 20 | 45 6e 64 6f 63 72 69 6e |diatric |Endocrin|
|000031e0| 6f 6c 6f 67 79 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |ology...|.-------|
|000031f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003200| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003210| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003220| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003230| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 4c 6f 6e 67 2d |--------|-..Long-|
|00003240| 54 65 72 6d 20 47 72 6f | 77 74 68 20 69 6e 20 4a |Term Gro|wth in J|
|00003250| 75 76 65 6e 69 6c 65 20 | 41 63 71 75 69 72 65 64 |uvenile |Acquired|
|00003260| 20 48 79 70 6f 74 68 79 | 72 6f 69 64 69 73 6d 3a | Hypothy|roidism:|
|00003270| 20 20 54 68 65 20 46 61 | 69 6c 75 72 65 20 74 6f |  The Fa|ilure to|
|00003280| 20 41 63 68 69 65 76 65 | 0d 0a 4e 6f 72 6d 61 6c | Achieve|..Normal|
|00003290| 20 41 64 75 6c 74 20 53 | 74 61 74 75 72 65 0d 0a | Adult S|tature..|
|000032a0| 0d 0a 52 69 76 6b 65 65 | 73 20 53 41 2c 20 42 6f |..Rivkee|s SA, Bo|
|000032b0| 64 65 20 48 48 2c 20 43 | 72 61 77 66 6f 72 64 20 |de HH, C|rawford |
|000032c0| 4a 44 0d 0a 28 4d 61 73 | 73 61 63 68 75 73 65 74 |JD..(Mas|sachuset|
|000032d0| 74 73 20 47 65 6e 20 48 | 6f 73 70 2c 20 42 6f 73 |ts Gen H|osp, Bos|
|000032e0| 74 6f 6e 3b 20 48 61 72 | 76 61 72 64 20 4d 65 64 |ton; Har|vard Med|
|000032f0| 20 53 63 68 6f 6f 6c 29 | 0d 0a 4e 20 45 6e 67 6c | School)|..N Engl|
|00003300| 20 4a 20 4d 65 64 20 33 | 31 38 3a 35 39 39 2d 36 | J Med 3|18:599-6|
|00003310| 30 32 2c 20 4d 61 72 63 | 68 20 31 30 2c 20 31 39 |02, Marc|h 10, 19|
|00003320| 38 38 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |88..----|--------|
|00003330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003340| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003350| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003360| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003370| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00003380| 0d 0a 0d 0a 20 20 20 20 | 20 49 6e 76 65 73 74 69 |....    | Investi|
|00003390| 67 61 74 6f 72 73 20 68 | 61 76 65 20 73 75 67 67 |gators h|ave sugg|
|000033a0| 65 73 74 65 64 20 74 68 | 61 74 2c 20 77 69 74 68 |ested th|at, with|
|000033b0| 20 70 72 6f 70 65 72 20 | 72 65 70 6c 61 63 65 6d | proper |replacem|
|000033c0| 65 6e 74 20 74 68 65 72 | 61 70 79 2c 0d 0a 63 61 |ent ther|apy,..ca|
|000033d0| 74 63 68 2d 75 70 20 67 | 72 6f 77 74 68 20 69 73 |tch-up g|rowth is|
|000033e0| 20 63 6f 6d 70 6c 65 74 | 65 20 61 6e 64 20 6e 6f | complet|e and no|
|000033f0| 72 6d 61 6c 20 61 64 75 | 6c 74 20 73 74 61 74 75 |rmal adu|lt statu|
|00003400| 72 65 20 69 73 20 61 74 | 74 61 69 6e 65 64 20 62 |re is at|tained b|
|00003410| 79 20 70 65 72 73 6f 6e | 73 20 77 69 74 68 0d 0a |y person|s with..|
|00003420| 6a 75 76 65 6e 69 6c 65 | 20 61 63 71 75 69 72 65 |juvenile| acquire|
|00003430| 64 20 68 79 70 6f 74 68 | 79 72 6f 69 64 69 73 6d |d hypoth|yroidism|
|00003440| 2e 20 20 54 68 69 73 20 | 61 73 73 75 6d 70 74 69 |.  This |assumpti|
|00003450| 6f 6e 20 77 61 73 20 74 | 65 73 74 65 64 20 69 6e |on was t|ested in|
|00003460| 20 61 20 63 6f 6d 70 72 | 65 68 65 6e 73 69 76 65 | a compr|ehensive|
|00003470| 0d 0a 65 76 61 6c 75 61 | 74 69 6f 6e 20 6f 66 20 |..evalua|tion of |
|00003480| 6c 6f 6e 67 2d 74 65 72 | 6d 20 67 72 6f 77 74 68 |long-ter|m growth|
|00003490| 20 69 6e 20 32 34 20 63 | 68 69 6c 64 72 65 6e 20 | in 24 c|hildren |
|000034a0| 28 31 38 20 67 69 72 6c | 73 29 20 77 69 74 68 20 |(18 girl|s) with |
|000034b0| 6a 75 76 65 6e 69 6c 65 | 0d 0a 68 79 70 6f 74 68 |juvenile|..hypoth|
|000034c0| 79 72 6f 69 64 69 73 6d | 2e 20 20 54 68 65 20 6d |yroidism|.  The m|
|000034d0| 65 61 6e 20 61 67 65 20 | 61 6e 64 20 6d 65 61 6e |ean age |and mean|
|000034e0| 20 62 6f 6e 65 20 61 67 | 65 20 6f 66 20 74 68 65 | bone ag|e of the|
|000034f0| 20 67 69 72 6c 73 20 77 | 65 72 65 20 31 31 2e 34 | girls w|ere 11.4|
|00003500| 20 79 65 61 72 73 20 61 | 6e 64 0d 0a 36 2e 32 20 | years a|nd..6.2 |
|00003510| 79 65 61 72 73 2c 20 72 | 65 73 70 65 63 74 69 76 |years, r|espectiv|
|00003520| 65 6c 79 3b 20 66 6f 72 | 20 74 68 65 20 62 6f 79 |ely; for| the boy|
|00003530| 73 20 74 68 65 73 65 20 | 77 65 72 65 20 31 30 2e |s these |were 10.|
|00003540| 35 20 79 65 61 72 73 20 | 61 6e 64 20 36 2e 34 20 |5 years |and 6.4 |
|00003550| 79 65 61 72 73 2c 0d 0a | 72 65 73 70 65 63 74 69 |years,..|respecti|
|00003560| 76 65 6c 79 2e 20 20 54 | 68 65 20 63 68 69 6c 64 |vely.  T|he child|
|00003570| 72 65 6e 20 68 61 64 20 | 73 65 76 65 72 65 20 70 |ren had |severe p|
|00003580| 72 69 6d 61 72 79 20 68 | 79 70 6f 74 68 79 72 6f |rimary h|ypothyro|
|00003590| 69 64 69 73 6d 2c 20 77 | 69 74 68 20 6d 65 61 6e |idism, w|ith mean|
|000035a0| 20 73 65 72 75 6d 0d 0a | 74 68 79 72 6f 78 69 6e | serum..|thyroxin|
|000035b0| 65 20 6c 65 76 65 6c 73 | 20 6f 66 20 6f 6e 6c 79 |e levels| of only|
|000035c0| 20 31 2e 31 20 6d 75 5f | 67 2f 64 6c 2e 20 20 41 | 1.1 mu_|g/dl.  A|
|000035d0| 74 20 64 69 61 67 6e 6f | 73 69 73 20 74 68 65 20 |t diagno|sis the |
|000035e0| 67 69 72 6c 73 27 20 68 | 65 69 67 68 74 73 20 77 |girls' h|eights w|
|000035f0| 65 72 65 0d 0a 34 2e 30 | 34 20 53 44 20 61 6e 64 |ere..4.0|4 SD and|
|00003600| 20 74 68 65 20 62 6f 79 | 73 27 20 33 2e 31 35 20 | the boy|s' 3.15 |
|00003610| 53 44 20 62 65 6c 6f 77 | 20 74 68 65 20 6d 65 61 |SD below| the mea|
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|000045c0| 20 31 39 38 39 0d 0a 0d | 0a 31 39 38 39 20 59 65 | 1989...|.1989 Ye|
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|000045e0| 72 69 6e 6f 6c 6f 67 79 | 20 28 52 29 0d 0a 0d 0a |rinology| (R)....|
|000045f0| 43 68 61 70 74 65 72 20 | 32 2d 2d 50 65 64 69 61 |Chapter |2--Pedia|
|00004600| 74 72 69 63 20 45 6e 64 | 6f 63 72 69 6e 6f 6c 6f |tric End|ocrinolo|
|00004610| 67 79 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |gy....--|--------|
|00004620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|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 0d 0a | 47 72 6f 77 74 68 20 69 |------..|Growth i|
|00004670| 6e 20 43 68 69 6c 64 72 | 65 6e 20 54 72 65 61 74 |n Childr|en Treat|
|00004680| 65 64 20 66 6f 72 20 41 | 63 75 74 65 20 4c 79 6d |ed for A|cute Lym|
|00004690| 70 68 6f 62 6c 61 73 74 | 69 63 20 4c 65 75 6b 61 |phoblast|ic Leuka|
|000046a0| 65 6d 69 61 0d 0a 0d 0a | 43 6c 61 79 74 6f 6e 20 |emia....|Clayton |
|000046b0| 50 45 2c 20 53 68 61 6c | 65 74 20 53 4d 2c 20 4d |PE, Shal|et SM, M|
|000046c0| 6f 72 72 69 73 2d 4a 6f | 6e 65 73 20 50 48 2c 20 |orris-Jo|nes PH, |
|000046d0| 50 72 69 63 65 20 44 41 | 0d 0a 28 52 6f 79 61 6c |Price DA|..(Royal|
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|00004700| 69 73 74 69 65 20 48 6f | 73 70 2c 20 4d 61 6e 63 |istie Ho|sp, Manc|
|00004710| 68 65 73 74 65 72 2c 20 | 45 6e 67 6c 61 6e 64 29 |hester, |England)|
|00004720| 0d 0a 4c 61 6e 63 65 74 | 20 31 3a 34 36 30 2d 34 |..Lancet| 1:460-4|
|00004730| 36 32 2c 20 46 65 62 20 | 32 37 2c 20 31 39 38 38 |62, Feb |27, 1988|
|00004740| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00004750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004790| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|000047a0| 0d 0a 20 20 20 20 20 49 | 6e 20 31 39 38 35 20 61 |..     I|n 1985 a|
|000047b0| 20 6c 61 72 67 65 20 6d | 75 6c 74 69 63 65 6e 74 | large m|ulticent|
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|000047f0| 74 72 65 61 74 65 64 20 | 66 6f 72 20 61 63 75 74 |treated |for acut|
|00004800| 65 20 6c 79 6d 70 68 6f | 62 6c 61 73 74 69 63 20 |e lympho|blastic |
|00004810| 6c 65 75 6b 65 6d 69 61 | 20 28 41 4c 4c 29 20 68 |leukemia| (ALL) h|
|00004820| 61 64 20 72 65 74 61 72 | 64 65 64 20 67 72 6f 77 |ad retar|ded grow|
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|00004890| 74 20 6c 65 61 64 73 20 | 74 6f 20 47 48 20 64 65 |t leads |to GH de|
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|00004940| 20 74 68 65 72 61 70 79 | 20 77 61 73 20 69 6e 64 | therapy| was ind|
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|00005ef0| 73 20 77 65 72 65 0d 0a | 6d 65 61 73 75 72 65 64 |s were..|measured|
|00005f00| 20 69 6e 20 70 6c 61 73 | 6d 61 20 73 61 6d 70 6c | in plas|ma sampl|
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|00005f20| 30 20 6d 69 6e 75 74 65 | 73 20 66 6f 72 20 31 32 |0 minute|s for 12|
|00005f30| 20 6f 72 20 32 34 20 68 | 6f 75 72 73 2c 20 61 6e | or 24 h|ours, an|
|00005f40| 64 20 74 68 65 0d 0a 66 | 69 6e 64 69 6e 67 73 20 |d the..f|indings |
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|00005f70| 6f 72 6d 61 6c 20 70 72 | 65 70 75 62 65 72 74 61 |ormal pr|epuberta|
|00005f80| 6c 20 63 68 69 6c 64 72 | 65 6e 2e 0d 0a 20 20 20 |l childr|en...   |
|00005f90| 20 20 43 68 69 6c 64 72 | 65 6e 20 77 69 74 68 20 |  Childr|en with |
|00005fa0| 47 48 20 64 65 66 69 63 | 69 65 6e 63 79 20 68 61 |GH defic|iency ha|
|00005fb0| 64 20 73 69 67 6e 69 66 | 69 63 61 6e 74 6c 79 20 |d signif|icantly |
|00005fc0| 6c 6f 77 65 72 20 6d 65 | 61 6e 20 32 34 2d 68 6f |lower me|an 24-ho|
|00005fd0| 75 72 20 47 48 20 6c 65 | 76 65 6c 73 0d 0a 74 68 |ur GH le|vels..th|
|00005fe0| 61 6e 20 6e 6f 72 6d 61 | 6c 20 63 68 69 6c 64 72 |an norma|l childr|
|00005ff0| 65 6e 20 68 61 64 20 28 | 46 69 67 20 32 2d 37 29 |en had (|Fig 2-7)|
|00006000| 2e 20 20 54 68 65 20 73 | 70 6f 6e 74 61 6e 65 6f |.  The s|pontaneo|
|00006010| 75 73 20 47 48 20 74 65 | 73 74 2c 20 68 6f 77 65 |us GH te|st, howe|
|00006020| 76 65 72 2c 0d 0a 69 64 | 65 6e 74 69 66 69 65 64 |ver,..id|entified|
|00006030| 20 6f 6e 6c 79 20 35 37 | 25 20 6f 66 20 74 68 65 | only 57|% of the|
|00006040| 20 63 68 69 6c 64 72 65 | 6e 20 77 69 74 68 20 47 | childre|n with G|
|00006050| 48 20 64 65 66 69 63 69 | 65 6e 63 79 20 69 64 65 |H defici|ency ide|
|00006060| 6e 74 69 66 69 65 64 20 | 62 79 20 74 68 65 0d 0a |ntified |by the..|
|00006070| 73 74 69 6d 75 6c 61 74 | 69 6f 6e 20 74 65 73 74 |stimulat|ion test|
|00006080| 73 2e 20 20 49 6e 20 74 | 68 65 20 72 65 6d 61 69 |s.  In t|he remai|
|00006090| 6e 69 6e 67 20 63 68 69 | 6c 64 72 65 6e 20 77 69 |ning chi|ldren wi|
|000060a0| 74 68 20 47 48 20 64 65 | 66 69 63 69 65 6e 63 79 |th GH de|ficiency|
|000060b0| 2c 20 73 70 6f 6e 74 61 | 6e 65 6f 75 73 0d 0a 68 |, sponta|neous..h|
|000060c0| 6f 72 6d 6f 6e 65 20 6c | 65 76 65 6c 73 20 77 65 |ormone l|evels we|
|000060d0| 72 65 20 77 69 74 68 69 | 6e 20 74 68 65 20 6e 6f |re withi|n the no|
|000060e0| 72 6d 61 6c 20 72 61 6e | 67 65 2e 20 20 43 68 69 |rmal ran|ge.  Chi|
|000060f0| 6c 64 72 65 6e 20 77 69 | 74 68 20 69 64 69 6f 70 |ldren wi|th idiop|
|00006100| 61 74 68 69 63 20 73 68 | 6f 72 74 0d 0a 73 74 61 |athic sh|ort..sta|
|00006110| 74 75 72 65 20 68 61 64 | 20 61 20 6e 6f 72 6d 61 |ture had| a norma|
|00006120| 6c 20 6d 65 61 6e 20 32 | 34 2d 68 6f 75 72 20 6c |l mean 2|4-hour l|
|00006130| 65 76 65 6c 20 6f 66 20 | 47 48 2c 20 61 6e 64 20 |evel of |GH, and |
|00006140| 6e 6f 6e 65 20 68 61 64 | 20 6c 6f 77 20 6c 65 76 |none had| low lev|
|00006150| 65 6c 73 20 6f 66 0d 0a | 73 70 6f 6e 74 61 6e 65 |els of..|spontane|
|00006160| 6f 75 73 20 47 48 20 73 | 65 63 72 65 74 69 6f 6e |ous GH s|ecretion|
|00006170| 2e 0d 0a 20 20 20 20 20 | 4d 65 61 73 75 72 65 6d |...     |Measurem|
|00006180| 65 6e 74 20 6f 66 20 74 | 68 65 20 73 70 6f 6e 74 |ent of t|he spont|
|00006190| 61 6e 65 6f 75 73 20 73 | 65 63 72 65 74 69 6f 6e |aneous s|ecretion|
|000061a0| 20 6f 66 20 47 48 20 69 | 6e 20 70 72 65 70 75 62 | of GH i|n prepub|
|000061b0| 65 72 74 61 6c 20 73 68 | 6f 72 74 0d 0a 63 68 69 |ertal sh|ort..chi|
|000061c0| 6c 64 72 65 6e 20 68 61 | 73 20 6c 6f 77 65 72 20 |ldren ha|s lower |
|000061d0| 73 65 6e 73 69 74 69 76 | 69 74 79 20 61 6e 64 20 |sensitiv|ity and |
|000061e0| 6f 66 66 65 72 73 20 6e | 6f 20 64 69 61 67 6e 6f |offers n|o diagno|
|000061f0| 73 74 69 63 20 61 64 76 | 61 6e 74 61 67 65 20 6f |stic adv|antage o|
|00006200| 76 65 72 0d 0a 73 74 69 | 6d 75 6c 61 74 69 6f 6e |ver..sti|mulation|
|00006210| 20 74 65 73 74 73 2e 20 | 20 54 68 65 73 65 20 64 | tests. | These d|
|00006220| 61 74 61 20 64 6f 20 6e | 6f 74 20 73 75 70 70 6f |ata do n|ot suppo|
|00006230| 72 74 20 74 68 65 20 72 | 6f 75 74 69 6e 65 20 6d |rt the r|outine m|
|00006240| 65 61 73 75 72 65 6d 65 | 6e 74 20 6f 66 0d 0a 73 |easureme|nt of..s|
|00006250| 70 6f 6e 74 61 6e 65 6f | 75 73 20 47 48 20 73 65 |pontaneo|us GH se|
|00006260| 63 72 65 74 69 6f 6e 20 | 69 6e 20 64 69 61 67 6e |cretion |in diagn|
|00006270| 6f 73 69 6e 67 20 47 48 | 20 64 65 66 69 63 69 65 |osing GH| deficie|
|00006280| 6e 63 79 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |ncy.....|Post-Com|
|00006290| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 44 6f 65 |ment....|     Doe|
|000062a0| 73 20 74 68 69 73 20 72 | 65 70 6f 72 74 20 74 65 |s this r|eport te|
|000062b0| 6c 6c 20 75 73 20 74 68 | 61 74 20 6f 75 72 20 74 |ll us th|at our t|
|000062c0| 72 69 65 64 2d 61 6e 64 | 2d 74 72 75 65 20 70 68 |ried-and|-true ph|
|000062d0| 61 72 6d 61 63 6f 6c 6f | 67 79 20 74 65 73 74 73 |armacolo|gy tests|
|000062e0| 20 66 6f 72 20 47 48 0d | 0a 72 65 73 65 72 76 65 | for GH.|.reserve|
|000062f0| 20 66 6f 72 20 61 64 65 | 71 75 61 74 65 20 61 6e | for ade|quate an|
|00006300| 64 20 74 68 61 74 20 66 | 75 72 74 68 65 72 20 69 |d that f|urther i|
|00006310| 6e 66 6f 72 6d 61 74 69 | 6f 6e 20 63 61 6e 6e 6f |nformati|on canno|
|00006320| 74 20 62 65 20 67 61 74 | 68 65 72 65 64 20 66 72 |t be gat|hered fr|
|00006330| 6f 6d 20 74 68 65 0d 0a | 6e 65 77 65 72 2c 20 73 |om the..|newer, s|
|00006340| 65 65 6d 69 6e 67 6c 79 | 20 6d 6f 72 65 20 70 68 |eemingly| more ph|
|00006350| 79 73 69 6f 6c 6f 67 69 | 63 20 74 65 73 74 73 3f |ysiologi|c tests?|
|00006360| 20 20 4f 6e 20 74 68 65 | 20 73 75 72 66 61 63 65 |  On the| surface|
|00006370| 2c 20 74 68 65 20 73 74 | 75 64 79 20 6f 66 20 52 |, the st|udy of R|
|00006380| 6f 73 65 20 61 6e 64 0d | 0a 63 6f 6c 6c 65 61 67 |ose and.|.colleag|
|00006390| 75 65 73 20 73 75 67 67 | 65 73 74 73 20 74 68 61 |ues sugg|ests tha|
|000063a0| 74 20 74 68 65 20 6d 6f | 72 65 20 74 69 6d 65 2d |t the mo|re time-|
|000063b0| 63 6f 6e 73 75 6d 69 6e | 67 2c 20 6c 61 62 6f 72 |consumin|g, labor|
|000063c0| 2d 69 6e 74 65 6e 73 69 | 76 65 2c 20 61 6e 64 20 |-intensi|ve, and |
|000063d0| 63 6f 73 74 6c 79 0d 0a | 74 65 73 74 73 20 61 72 |costly..|tests ar|
|000063e0| 65 20 6e 6f 74 20 65 76 | 65 6e 20 61 73 20 72 65 |e not ev|en as re|
|000063f0| 6c 69 61 62 6c 65 20 61 | 73 20 74 68 65 20 6d 6f |liable a|s the mo|
+--------+-------------------------+-------------------------+--------+--------+