EP0871392A1 - Method of diagnosing pituitary dependent growth hormone deficiency - Google Patents
Method of diagnosing pituitary dependent growth hormone deficiencyInfo
- Publication number
- EP0871392A1 EP0871392A1 EP96908837A EP96908837A EP0871392A1 EP 0871392 A1 EP0871392 A1 EP 0871392A1 EP 96908837 A EP96908837 A EP 96908837A EP 96908837 A EP96908837 A EP 96908837A EP 0871392 A1 EP0871392 A1 EP 0871392A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- trp
- growth hormone
- ghrp
- phe
- ghrh
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- C07K14/575—Hormones
- C07K14/60—Growth-hormone releasing factors (GH-RF) (Somatoliberin)
-
- G—PHYSICS
- G01—MEASURING; TESTING
- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
- G01N33/5091—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing the pathological state of an organism
-
- G—PHYSICS
- G01—MEASURING; TESTING
- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/74—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving hormones or other non-cytokine intercellular protein regulatory factors such as growth factors, including receptors to hormones and growth factors
-
- G—PHYSICS
- G01—MEASURING; TESTING
- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
- G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
- G01N2333/575—Hormones
- G01N2333/61—Growth hormones [GH] (Somatotropin)
Definitions
- the present invention provides a method for directly testing pituitary GH secretory capability in children and adults with clinical symptoms of growth hormone deficiency.
- GH growth hormone
- the non-specific provocative agents whose action may be mediated, at least in part, by release of growth hormone releasing hormone (GHRH) from the brain cannot differentiate between deficient hypothalamic GHRH stores or release capabilities from unresponsive pituitary-GHRH transduction mechanisms.
- GHRH growth hormone releasing hormone
- an objective of the present invention to provide a diagnostic protocol that can differentiate between various etiologies of GH deficiency in both children and adults.
- a diagnostic protocol and kit for evaluating pituitary growth hormone (GH) secretory capability as a means to identify the etiology of GH deficiency in children and adults includes measuring GH secretion, as determined by changes in serum, plasma, or whole blood GH concentrations following administration of the xenobiotic GH releasing hexapeptide (GHRP-6) or any of its peptidyl or non-peptidyl synthetic analogues that release GH by the same cellular mechanism as GHRP-6 (the group/family of compounds are referred to as GHRX) .
- GHRP-6 xenobiotic GH releasing hexapeptide
- GHRX group/family of compounds
- the naturally occurring GH releasing compound (GHRC) or its analogues is administered to children and adults afflicted with disorders related to GH deficiency and GH secretion is measured.
- the changes in serum, plasma or whole blood concentrations of GH following individual administration of these two different GH secretagogues is then expressed as a ratio of peak GH concentrations for GHRX divided by peak GH concentrations for GHRH. This ratio is then used to compare the results for the subject being tested against values derived from normal subjects for reference purposes.
- the effect of the co-administered GH secretagogues on blood GH concentrations in the child or adult subject is then measured.
- the ratio provides a relative measure of the deficiency for each endogenous secretagogue in reference to the co-secretagogue. This is useful in selecting the therapeutic dose for treatment since the more the ratio deviates from the normal range the more aggressive the treatment must be.
- the present invention provides a new and more effective way to use stimulated GH secretion as a reliable and effective tool for directly evaluating pituitary GH secretory capability and for differentiating specific extra-pituitary factors from intra-pituitary factors that contribute to GH deficiency in children and adults afflicted with medical disorders related to such a hormone deficit.
- FIGURE 1 is a diagram of the three step provocative testing of the present invention.
- FIGURE 2 is a dose response curve for GHRP-6 in rats pretreated with vehicle (triangles) , ⁇ r-methyl-p- tyrosine (circles) , or GHRH antiserum (squares) . Values represent means ⁇ SEM (8 rats per dose and treatment) in plasma collected 15 minutes after administration of GHRP- 6.
- FIGURE 3 is a dose response curve showing the effect of [N-Ac-Tyr 1 , D-Arg 2 ] -GRF 1-29 amide, a GH receptor antagonist, on GH release in response to GHRP-6 (30 ⁇ g/kg, closed symbols, panel A) or morphine (1.5 mg/kg, open symbols, panel B) .
- the GHRH receptor antagonist was administered in doses of 0 (circle) , 5 (square) , 50 (triangle) , or 150 (diamond) ⁇ g/kg. Values represent mean ⁇ SEM 8 rats per group.
- FIGURE 4A-D is a series of dose response curves showing the GHRP-6/GHRH ratio over time after challenge in (A) a control subject, (B) a hypopituitary subject, (C) a constitutional delay subject, and (D) an irradiated subject.
- the present invention provides a diagnostic procedure and kit for determining whether growth hormone deficiency in children and adults is due to a deficiency in endogenous growth hormone releasing hormone, to a deficiency of the endogenous analogue of a new family of xenobiotic GH secretagogues (GHRX) , the prototype of which is GHRP-6, to a deficiency of both endogenous GH secretagogues, or due to intrinsic defects in the pituitary gland not involving either GH secretagogue, that result in GH deficiency.
- GHRX xenobiotic GH secretagogues
- GHRH has been identified as a naturally occurring GH secretagogue, an endogenous analogue of a group referred to as GH releasing compound (GHRC) .
- GHRP-6 represents a synthetic analogue of another, yet unidentified, endogenous GH secretagogue.
- the relationship between GHRP-6 and its endogenous counterpart is presumably analogous to that of morphine and the endorphins.
- GHRH and GHRP-6 are functional complements, the response of one is amplified in the presence or under the influence of the other. Therefore, robust GH secretion in response to administration of GHRH or GHRP-6 could be interpreted as representing adequate endogenous GHRP-6 or GHRH, respectively.
- a poor response to either GH secretagogue administered individually could represent inadequacy of its endogenous complement. The paradox in this hypothesis is that a normal response to a provocative challenge by a given GH secretagogue will be observed for the peptide that is lacking or deficient in the patient.
- the integrity of functional pituitary elements can be differentiated from inadequate concentrations of both endogenous complements by administering the GH secretagogues simultaneously.
- GH secretion in response to co-administered GHRH and GHRP-6 would indicate inadequate endogenous GH secretagogues, whereas lack of GH secretion in response to the co-administered secretagogues would indicate intrinsic defect (s) in pituitary functional capacity.
- the basis of the diagnostic test is a comparison of responses to provocative challenges of exogenous GH secretagogues administered sequentially and in combination.
- GHRH and GHRP-6 are used as the GH secretagogues.
- the invention will be discussed mainly in terms of GHRH and GHRP-6. The invention, however, may be applied in an analogous fashion with the analogues of these two GH secretagogues.
- the analogues for xenobiotic GHRP-6 include peptidyl and non-peptidyl forms of GHRP-6-like xenobiotic GH secretagogues that release growth hormone from the pituitary gland by the same cellular mechanism as GHRP-6.
- the group/family of these related molecules will be designated as GHRX for convenience.
- the analogues of GHRH are members of a group of GH secretagogue referred to as growth hormone releasing compound (GHRC) such as GH releasing hormone (GHRH) , GH releasing factor or any of its synthetic analogues that release GH from the pituitary gland by the same cellular and molecular mechanism as GHRH.
- GHRC growth hormone releasing compound
- the diagnostic procedure of the present invention is carried out by establishing baseline levels of growth hormone (GH) in the blood of the child or adult being evaluated. Sequentially provocative challenges are then administered of a GHRC and GHRX, and then the combination of the GH secretagogues is administered. The levels of growth hormone in the blood of the patient is measured thereby determining if GH level changes after each of the three different administrations has occurred. The order of the provocative challenges can be changed as long as enough time between injections is provided for clearance of the previous challenge.
- GH growth hormone
- GHRH and the in vivo endogenous analogue of GHRP-6 are present in normal concentrations (Column 2, Table 1) . Therefore, the injection of either GHRC or GHRX will release concentrations of GH that are normal and that reflect the presence of the endogenous and exogenous GHRH and GHRP.
- GHRC will release subnormal amounts of GH, if at all.
- the injection of GHRX will release a normal quantum of GH.
- both endogenous GH secretagogues are insufficient or absent (Column 5, Table 1) , then GHRC or GHRX administered individually will release subnormal quanta of GH, if at all. If the co-administration of GHRC and GHRX release a normal quanta of GH, then both endogenous secretagogues are absent or insufficient. If no or reduced GH is released (Column 6, Table 1) than an intrinsic defect in the pituitary gland not involving either GH secretagogue has been shown.
- the responses are evaluated as representing optimal concentrations of both endogenous GH secretagogues or deficiencies of one or the other endogenous complementary secretagogue by calculating a ratio of peak GH concentrations for GHRX divided by peak GH concentrations for GHRH.
- the normal range of ratios is calculated and the response of the patient compared with the normal values.
- a ratio in the range of 1.4 to 2.5 is considered in the normal range while a ratio of less than 1.4 indicates a deficiency in endogenous GHRH and a ratio greater than 2.5 indicates a deficiency in endogenous GHRP.
- a deficiency in both endogenous peptides would produce a ratio in the normal range. Therefore, whenever a normal ratio is observed the peak values must be checked to determine if the peak responses were in the normal range (Table 1) . If not, then the patient is deficient in both endogenous GH secretagogues.
- the ratio provides a relative measure of the deficiency for each endogenous secretagogue in reference to the co-secretagogue. This is useful in selecting the therapeutic dose for treatment since the more the ratio deviates from the normal range the more aggressive the treatment must be.
- the growth hormone levels in the blood of the child or adult can be measured by any well known procedures, e.g., using an immunoradiometric assay as described by Bowers et al . (1990) or any other contemporary, scientifically accepted method.
- any growth hormone releasing compound can be utilized in the diagnostic procedure of the present invention.
- GHRH is the preferred growth hormone releasing compound for use in the claimed invention.
- the growth hormone releasing compounds which may be used in practicing the present invention are any such compounds known to induce growth hormone (GH) secretion and include growth hormone releasing hormone (GHRH) (1-44) and analogues GHRH (1-40) and GHRH (1-29) thereof .
- GHRH growth hormone releasing hormone
- GHRH growth hormone releasing hormone
- GHRH growth hormone releasing hormone
- U.S. Patent 4,622,312 provides an excellent description of GHRH and analogue thereof, which can be used in the presently claimed invention.
- Reissue patent RE33,699 provides a summary of patents which teach growth hormone releasing compounds.
- the growth hormone releasing compounds taught in each of the following U.S. patents are suitable for invention.
- Reissue Patent No. RE 33,699 provides a summary of patents which teach growth hormone releasing compounds taught in each of the following U.S. patents are suitable for use in the method of the present invention:
- GHRP-6 and analogues thereof means GHRP-6 and any peptide or nonpeptide compound that releases GH by the same cellular mechanism.
- analogue Dorland ' s Illustra ted Medical Dictionary, 25th Edition, W.B. Saunders, Philadelphia, PA., p. 78
- analogue in the present invention is used to refer to functional and metabolic analogues that are peptides or nonpeptides that cause the release of GH by the same cellular mechanism as GHRP-6, i.e., they are compounds of similar activity.
- GHRP-6 is the hexapeptide His-D-Trp-Ala-Trp-D-Phe-Lys-NH 2 which is believed to act directly on the pituitary to release GH.
- the pentapeptide Tyr- D-Trp-Gly-Phe-Met-NH 2 (Cheng et al . , 1989) is a useful analogue in the release of GH.
- a nonpeptide functional or metabolic analogue of GHRP-6 has been disclosed by Smith et al . (1993) that acts through the same site as GHRP-6.
- the compound, L-692,429 is antagonized by the same agents as is GHRP-6 and interacted with GRF.
- This and related compounds activate the same cellular receptors and second messengers as GHRP- 6 in the course of initiating its relevant action (e.g. growth hormone release) . All of these analogues and compounds of similar activity are useful in practicing the present invention as described herein; however, these peptides and nonpeptides should not be considered as being exhaustive of the GHRP-6 analogue-compounds useful in practicing the present invention.
- the provocative challenges can be administered on the same day provided adequate time for clearance of the previous challenge occurs between. Clearance is determined by monitoring the blood levels of GH and when they return to the base line established prior to the first provocative challenge, clearance has occurred.
- the quantities of each agent to be administered is any quantity known to be effective in causing an increase in growth hormone levels., i.e., an amount which will stimulate release of growth hormone, and are adjusted to take into account age, sex and body weight as are known in the medical arts. In general, 1 ⁇ g/kg body weight has been found to be effective.
- the patients are selected for evaluation by the inventive protocol according to the following criteria.
- Slow growth in children or disorders in children and adults associated with growth hormone deficiency, with or without low blood concentrations of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IBP-3) are candidates for the differential diagnostic procedure.
- IGF-1 insulin-like growth factor-1
- IBP-3 insulin-like growth factor binding protein-3
- the present invention also provides for a kit for the differential diagnosis of pituitary dependent growth hormone deficiency.
- the kit includes an amount of growth hormone releasing compound (GHRC) known to be effective to cause an increase in growth hormone levels in the blood to be administered to the patient for a provocative challenge.
- the kit also includes an amount of a molecule known to be effective to cause an increase in growth hormone levels in the blood, the molecule being selected from GHRP-6 or an analogue of GHRP-6 which causes release of growth hormone by the same cellular mechanism as GHRP-6 (GHRX) .
- Enough material of each agent is included in order to administer each agent individually for a provocative challenge as well as to co-administer the two agents.
- the kit can optionally also include the reagents for measuring GH levels in the blood of patients following the provocative challenge.
- the kit can optionally be configured for testing for multiple patients or for a single patient.
- GHRH may not be the only endogenous agent that provides stimulation for GH secretion.
- a xenobiotic hexapeptide, GHRP-6 which has different binding characteristics from GHRH (Codd et al . , 1989; Blake, et al . , 1991) and utilizes a different somatotroph second messenger system (Cheng et al . , 1989) is a GH secretagogue that potentiates GHRH efficacy
- age-related pituitary GH hyposecretion probably reflects decrements in the combined influence of several peptides, including SRIF on the pituitary, requiring analysis of responses to co- administered substances as provocative, diagnostic challenges.
- This hypothesis is in agreement with a report in which GH regulation was shown to be complex, involving several secretagogues acting in concert with GHRH to provide tightly controlled, temporal and quantitative secretion of GH (Goth et al . , 1992) .
- applicants devised a model for direct testing of pituitary, growth hormone secretory capability (Fig. 1) .
- the present invention provides a new clinical application for the co-secretagogues GHRP-6 and GHRH and other synthetic GH secretagogues that function by the same mechanism as GHRP-6 or GHRH.
- the invention is important because it not only provides a reliable method for identifying children and adults with low GH secretory capability, but also helps diagnose the etiology of GH deficiency and provides a key to appropriate treatment . Once a child or adult is diagnosed as having either a deficiency in either or both endogenous GHRH and GHRP, the appropriate replacement therapy can ensue whereby either a growth hormone releasing compound, a GHRP-6 or analogue thereof or a combination of both GH secretagogues is administered to the child or adult.
- the patient is administered GHRC at a dose ranging from 100 ng/kg body weight to 100 mg/kg body weight.
- the GHRC is administered and blood samples are monitored over a period of 120 minutes to determine whether the exogenous GHRC increased growth hormone levels.
- the patient is administered GHRP-6 or an analogue thereof at a dose of 100 ng/kg body weight to 1 mg/kg body weight. Blood samples are measured for any change in growth hormone levels for 120 minutes as for GHRC administration.
- Co-administration of both GH secretagogues then follows with the same dosages levels. Additional administration of peptides may be made, but a day of rest, i.e., a day during which neither GH secretagogue is administered, may intervene administration days and, in one embodiment, each provocative challenge is spaced twenty-four hours apart.
- the dosage amount can be varied to determine optimal dosages. The changes, if any, in growth hormone levels to either or both of GHRC or GHRX thereof will provide an insight to the etiology of the GH deficient condition of the patient.
- GHRH-efficacy has been reported to be reduced 50 to 75% in old rats (Sonntag et al . , 1983) ; therefore, applicants tested the effect of GHRP-6 alone and in combination with GHRH on GH release in old rats. Peak plasma GH concentrations resulting from GHRP-6 administration in old rats were approximately 60% less than in young rats. In contrast, peak plasma GH concentrations were greater in old rats than in young rats administered GHRP-6 and GHRH. Since target organs sometimes become hyperresponsive when tonic and/or phasic stimulation decreases, than one would expect exaggerated responses to provocative exogenous stimuli under experimental conditions.
- GH hypersecretion observed in naive, old rats administered a single bolus of GHRH and GHRP (Walker et al. , 1991) provides support for the hypothesis that deficits in stimulated GH secretion in aged rats were due to insufficient signals or inappropriately transduced GH releasing stimuli.
- Young rats were passively immunized against endogenous GHRH or administered ⁇ -methyl-p-tyrosine. If GHRH and the endogenous ligand of GHRP-6 are physiological co-agonists of GH secretion in the young rat, then removal of one or the other should be expressed as attenuated activity of its co-agonist when administered alone. Passive immunization which inactivates GHRH with neutralizing antibodies, or cx-methyl-p-tyrosine (L form) which blocks stimulation of hypothalamic GHRH neurons were used to remove or reduce concentrations of endogenous GHRH in the young experimental animals .
- GHRP-6 activity was significantly attenuated in young female rats administered GHRH antiserum or ⁇ -methyl-p-tyrosine to reduce endogenous GHRH concentrations.
- GHRH antiserum or ⁇ -methyl-p-tyrosine was significantly attenuated in young female rats administered GHRH antiserum or ⁇ -methyl-p-tyrosine to reduce endogenous GHRH concentrations.
- naturally occurring decrements in endogenous GHRH during aging contributed to the blunted response to GHRP-6 that applicants observed (Walker et al . , 1991) .
- GHRH activity is also dependent upon a yet unidentified endogenous co-secretagogue whose concentrations decline during aging, then applicants' data support the hypothesis that extrinsic pituitary deficits contribute, at least in part, to attenuated GH secretory responses to administered GHRH.
- EXAMPLE 2 A study in children has been performed. The results of this study support the basic concept of GH secretagogue complementarily as a useful diagnostic tool for evaluating pituitary-based, GH deficiency.
- the protocol used in the pediatric study from which data presented below were collected involved the sequential administration of exogenous GHRP and exogenous GHRH as set forth in the present invention (Table 1, Figure 1) . Briefly, each subject began testing at approximately 0900 h, one half hour after placement of an intravenous catheter. Two blood samples for basal concentrations of serum GH were drawn, and GHRP (1 ⁇ g/kg) was administered as a bolus . Blood samples were then drawn at five minute intervals for 20 minutes during which the GH secretory response occurred, and at longer intervals for about two hours thereafter.
- GHRH (1 ⁇ g/kg) was then administered as a bolus, when basal GH concentrations were again established. Blood samples were similarly collected after GHRH administration as they were following GHRP administration. GH concentrations in each serum was then determined by radioimmunoassay.
- the study population was composed of children with normal GH secretory function (serving as controls and normal baseline values) and those with GH secretory dysfunction of various clinical diagnoses .
- the purpose of evaluating different etiologies of GH secretory dysfunction was to validate the hypothesis that complementary endogenous GH secretagogues must be present for optimal expression of GHRP or GHRH stimulatory potential.
- peak concentrations of serum GH were reached at the 15 or 20 minute time point following stimulation with both secretagogues.
- peak GH concentrations following GHRP-6 administration were greater than those following GHRH administration.
- the greater response to the xenobiotic GH secretagogue was not due to its being administered first, because reversal of the sequence produced the same differential response.
- Peak concentrations of serum GH following GHRP-6 administration in normal children ranged between 42 and 66 ng/ml, whereas peak concentrations of serum GH following GHRH administration ranged between 18 and 36 ng/ml.
- the ratio of GHRP-6 to GHRH evoked responses in the normal children ranged between 1.8 (66/36) and 2.3 (42/18) , reflecting the greater responses to GHRP-6 in these subjects.
- GHRP-6:GHRH ratios between 1.4 and 2.5 reflected the "normal concentrations" of endogenous GH secretagogues contributing to the peak concentrations measured in normal individuals;
- peak concentrations of serum GH in response to exogenous GHRP-6 or GHRH should occur within 15 or 20 minutes of their administration.
- Fig. 4B show that children with inherently dysfunctional pituitary glands did not respond to any combination of exogenous GH secretagogue administration.
- This representative subject had atrophic, developmentally retarded pituitary gland which responded to neither sequentially administered GHRH and GHRP-6 nor to the co-administered peptides.
Abstract
Description
Claims
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US40584295A | 1995-03-17 | 1995-03-17 | |
US405842 | 1995-03-17 | ||
PCT/US1996/003607 WO1996029002A1 (en) | 1995-03-17 | 1996-03-14 | Method of diagnosing pituitary dependent growth hormone deficiency |
Publications (2)
Publication Number | Publication Date |
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EP0871392A1 true EP0871392A1 (en) | 1998-10-21 |
EP0871392A4 EP0871392A4 (en) | 2001-08-29 |
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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EP96908837A Withdrawn EP0871392A4 (en) | 1995-03-17 | 1996-03-14 | Method of diagnosing pituitary dependent growth hormone deficiency |
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EP (1) | EP0871392A4 (en) |
WO (1) | WO1996029002A1 (en) |
Families Citing this family (1)
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GB0603295D0 (en) | 2006-02-18 | 2006-03-29 | Ardana Bioscience Ltd | Methods and kits |
Family Cites Families (2)
Publication number | Priority date | Publication date | Assignee | Title |
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US5246920A (en) * | 1992-06-15 | 1993-09-21 | University Of South Florida | Treatment of hyperprolactinemia |
CA2139326A1 (en) * | 1992-06-29 | 1994-01-06 | Barry B. Bercu | Diagnostic procedure for evaluating short stature etiology |
-
1996
- 1996-03-14 WO PCT/US1996/003607 patent/WO1996029002A1/en not_active Application Discontinuation
- 1996-03-14 EP EP96908837A patent/EP0871392A4/en not_active Withdrawn
Non-Patent Citations (3)
Title |
---|
BERCU, B.B ET AL.: "Evaluation of Pituitary Function in Children Using Growth Hormone Secretagogues" JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, vol. 9, no. 3, October 1995 (1995-10), pages 325-332, XP000904755 * |
POPOVIC, V. ET AL.: "Growth Hormone (GH) Secretion in Active Acromegaly after the Combined Administration of GH-Releasing Hormone and GH-Relesing Peptide-6" THE JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, vol. 79, no. 2, August 1994 (1994-08), pages 456-460, XP000901920 * |
See also references of WO9629002A1 * |
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Publication number | Publication date |
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EP0871392A4 (en) | 2001-08-29 |
WO1996029002A1 (en) | 1996-09-26 |
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