30

30

i 30

ii 30 1 p. 1 2 p. 8 3 PRL p. 12 4 p. 15 5 SIADHp. 18 6 p. 21 7 p. 23 8 p. 25 9 TSH p. 29 10 p. 31 11 p. 35 12 p. 36 13 ACTH p.40 14 PRL p. 43 15p. 44 16 TSH p. 50 17 p. 52 18 p. 54 19 IgG4 p. 59 p. 60

1 30 I 1 1 2 3 II 1 GH GH 75 g 2 2 IGF-1 C 3 3 MRI CT 4 III 1 2 3 4 5 6 7 8 9 10 X 5 I II 1 2 GH 0.4 ng/ml GH GH GH GH GH GH TRH LHRH GH 3 IGF-1 4 GHRH GH

2 5 X X X heel pad 22 mm GH IGF-1 I 185 cm 175 cm II III IV I II IV 2SD

3 IGF-1 (ng/ml) Isojima T et al., 2012 Endocr J 59 771 2SD 2SD 2SD 2SD 0 11 67 149 15 69 154 1 14 69 148 23 85 186 2 18 74 154 32 99 213 3 24 82 164 40 108 227 4 32 93 176 48 116 238 5 44 108 193 56 126 252 6 55 124 215 69 147 287 7 63 142 247 89 183 357 8 72 165 292 111 224 438 9 84 195 350 133 264 517 10 99 233 423 155 302 588 11 113 272 499 175 333 638 12 125 301 557 188 348 654 13 133 315 579 193 349 643 14 138 315 570 193 344 625 15 141 310 552 192 341 614 16 142 307 543 192 340 611 17 142 306 540 191 335 599 18 142 301 526 188 326 574 19 143 292 501 182 311 539 20 142 280 470 175 293 499 21 139 265 436 168 275 459 22 135 251 405 161 259 425 23 131 237 379 155 247 397 24 128 226 356 151 237 375 25 125 216 337 147 228 358 26 119 212 329 146 223 336 27 116 208 322 141 217 328 28 114 203 315 137 212 320 29 111 199 309 133 206 312 30 109 195 303 129 201 304 31 107 191 297 126 196 297 32 105 187 292 122 192 290 33 103 184 287 119 187 283 34 102 181 283 115 183 277 35 100 178 279 112 178 271 36 99 175 275 109 174 265 37 97 173 272 106 170 260

4 38 96 171 269 103 166 254 39 95 168 266 100 163 250 40 94 166 263 98 159 245 41 94 165 261 95 156 240 42 93 163 259 93 153 236 43 92 161 257 90 150 233 44 92 160 255 88 147 229 45 91 159 253 87 145 226 46 90 157 250 85 142 224 47 90 156 250 83 140 221 48 89 154 248 82 138 219 49 88 153 246 81 137 218 50 87 152 245 80 135 216 51 87 151 243 79 134 215 52 86 149 242 78 133 213 53 85 148 240 77 131 212 54 84 147 239 76 130 211 55 84 146 238 75 129 210 56 83 145 237 74 128 208 57 82 144 236 73 126 207 58 81 143 235 72 125 205 59 80 142 233 71 123 203 60 79 141 232 70 121 201 61 77 140 230 69 120 198 62 76 138 228 68 118 196 63 75 137 226 66 116 194 64 73 135 224 65 114 191 65 72 134 221 64 112 188 66 70 132 219 62 110 186 67 68 130 216 61 109 183 68 66 128 213 60 107 180 69 65 126 209 59 105 177 70 63 124 206 57 103 175 71 61 122 202 56 101 172 72 58 119 198 55 100 170 73 56 117 194 54 98 167 74 54 114 190 53 96 165 75 52 112 185 52 95 163 76 50 109 181 50 93 160 77 48 106 177 49 92 158

5 I GH II 1 GH 1 2 1 1 100 300 μg 2 3 4 1 10 40 mg 4 1 60 120 mg 4 1 20 60 mg 2 GH 1 1 10 30 mg 3 1 2.5 15 mg 2 3 3 2

6 3 4 IGF-1 1 75 g GH 1 2 1 IGF-1 75 g GH 0.4 ng/ml 3 4 2 1 3 3 IGF-1 75 g GH 0.4 ng/ml 2 1 IGF-1 GH 5 GH 1 ng/ml 6 2 3 5 1 3 1 3 6 1 6 12 2 7 3 1 IGF-1

7 2 IGF-1 IGF-1 3 6 3 0.4 ng/ml GH GH GH GH 4 2 5 GH GH 6 IGF-1 GH GH 7 IGF-1 GH 1 3 MRI

8 30 I 1 1 1 2 3 1 cm 4 5 6 2 1 2 3 4 5 6 7 8 9 1. 2. II 1 ACTH 2 2 3 1 2 ACTH III III 1 0.5 mg 8 10 4 2 5 μg/dl 5 1 2 ACTH ACTH IV 1 CRH CRH 100 μg ACTH 1.5 6

9 2 8 mg 8 10 7 3MRI 8 4 9 ACTH C/P 2 CRH 3 10 I 1 I 2 II III IV 1 2 3 4 I II III 1 2 8 10 30 ACTH 10 CBG 3 24 70 μg/ 100 μg/ 4 1 2 mg 0.5 mg 3 μg/dl 5 μg/dl ACTH CYP3A4 1 mg 1.8 μg/dl 5 6 DDAVP 4 μg ACTH 1.5 DDAVP 7 8 mg 1/2 8 3 MRI MRI 9 MRI 10 ACTH C/P 2 CRH 3 ACTH

10 ACTH C/P 3 CRH 5 PRL I QOL II ACTH QOL 1 1 1 2 1 ACTH ACTH 1 4 1 10 40 mg 2 1 1 mg 1 2 1/3 3 2 1 11β

11 1 250 mg 1 1 1 500 1000 mg 1 3 15 20 mg/ 0.5 1 mg/ 24 2 3β 1 60 mg 1 3 4 1 480 mg 3 1 250 500 mg 1 3 CYP3A4 3 2 4 5 6 1 1 1 μg/dl 1 2

12 PRL 30 PRL I 1 2 3 II PRL 1 III PRL 1 1 PRL 2 2 TSH 3 1 2 CT MRI 1 1 2 2 PRL PRL PRL 2 1 5 6 I II 1 PRL PRL PRL PRL 2 2 2 PRL

13 1 PRL 1 1 PRL 2 PRL 2 1 2 1 2 3 4 3 2 4 5 6 1 2 3 PRL PRL PRL PRL 15 25 PRL PEG IgG PRL 2 PRL α- H2

14 PRL 1 PRL 1 0.25 mg/ PRL 1 mg/ 2.5 mg/ PRL 5 7.5 mg/ 2 3 2 1 2 3 4 5 PRL 1 2 3 4 2 PRL

15 30 I 1 2 3 II 1 1 3,000 ml 40 ml/kg 2,000 ml/m 2 2 300 mosm/kg 3 5 0.05 ml/kg/min 120 4 3 6.5 300 mosm/kg 5 5 30 2 300 mosm/kg 1 III 1 1 2 3 MRI T1 2 IV 1 2 V2 2 I II 1 2 3 II 1 2 4 5 1 2 3

16 1 2 1

17 1 2.5 μg/ 60 μg/ 1 1 2.5 10 μg/ 1 2 60 μg/ 1 2 3 2

18 SIADH 30 SIADH 3 SIADH I II 1 135 meq/l 2 280 mosm/kg 3 4 100 mosm/kg 5 20 meq/l 6 7 III 1 2 1 3 5 ng/ml/h 4 5 mg/dl 5 IV 1 2 3

19 I II 1 SIADH SSRI

20 SIADH 1 2 1 1 kg 15 20 ml 3 9 g/ 3/ 4 120 meq/l 3 3 3 100 ml/10 24 10 meq/l 48 18 meq/l 120 meq/l 3 110 meq/l 5 24 10 meq/l 48 18 meq/l 3 5 6 V2 30 mg 1 1 1 3 7 V2 SIADH

21 30 I 1 1 2 3 II 2 1 1 3,000 ml 40 ml/kg 2,000 ml/m 2 2 300 mosm/kg 3 1.0 pg/ml 4 3 5 300 mosm/kg 6 III IV V2 2 I II 1 2 3 4 6 II 1 2 3 5 6 III IV I II 1 2 3 4 6 1 2 3 5 6 III 1 2 3

22

23 30 LH FSH) LH FSH α- β- I 1 2 3 II 1 2 LH FSH III IV FSH LH V I II III V I II V SF-1 FSH LH β- α-

24 1 2 3

25 30 I 1 1 9 2 10 3 11 2 1 7 6 2 8 3 10 6 II 1 1 2.0SD 1.5SD 2 2 6 5 1.6 3 1.5 III 2 IV 3 4 McCune-Albright hcg LHRH hcg hmg rfsh 5 V GPR54 KISS-1 MKRN3 DLK1 1 I 2 III IV 2 I 1 II 1 III IV

26 I 1 1SD 1 2 1 3 4 5 1 10 10 Tanner 2-3 Tanner 4-5 LH miu/ml 0.02-0.15 0.04-0.25 0.44-1.63 1.61-3.53 LH miu/ml 1.70-3.77 2.03-11.8 10.9-20.6 21.7-39.5 FSH miu/ml 0.38-1.11 0.95-3.57 1.73-4.27 4.21-8.22 FSH miu/ml 4.38-9.48 5.69-16.6 4.68-10.8 11.2-17.3 LH/FSH 0.03-0.24 0.03-0.08 0.16-0.63 0.24-0.70 LH/FSH 0.28-0.55 0.26-0.99 1.4-3.4 1.3-3.3 10 10 Tanner 2-3 LH miu/ml 0.01-0.09 0.02-0.11 0.05-2.44 LH miu/ml 1.93-4.73 2.14-7.82 5.70-18.5 FSH miu/ml 0.54-2.47 1.16-3.65 1.49-5.95 FSH miu/ml 10.7-38.1 13.2-21.1 6.98-14.3 LH/FSH 0.01-0.08 0.02-0.03 0.03-0.42 LH/FSH 0.09-0.25 0.15-0.41 0.74-1.4

27 I II LHRH III 1 LHRH LHRH 4 1 30 μg/kg 1 180 μg/kg 6 LHRH 2 LHRH 1 LHRH BMI 3 SD 13

28 15 LHRH 3 6 2 LH

29 TSH 30 TSH I 1 1 2 3 II 1 T4 TSH Syndrome of Inappropriate Secretion of TSH; SITSH 2 3 TSHβ TSH III 1 TRH TSH TSH 2 2 2 3 4 TSH 5 SITSH T4 T3 IgG TSH TSH IV β I II I II 1 2 1 2

30 TSH TSH 50 75 TSH TSH TSH

31 30 I 1 1 2.0SD 2 2 1.5SD 3 2 4 2 3 3 II GH 5 L-DOPA GHRP-2 6 7L-DOPA 120 180 30 GH 6 ng/ml GHRP-2 60 15 GH 16 ng/ml III 1 2 24 3 4 20 GH 3 IGF-1 4 8 80 1 I 1 II 2 2 I 2 I 1 3 II 1 1 I 1 2 III 4 3 2 I 1 II 1 III 2 3 I 1 3 III 2

32 1 I 1 II 2 GH 3 ng/ml GHRP-2 10 ng/ml 2 I 2 I 1 3 II 1 GH 3 ng/ml GHRP-2 10 ng/ml GH 6 ng/ml GHRP-2 16 ng/ml 9 1 2 11 9 3 4 6 1 2 1.5SD 5 2 6 ² ² DDAVP ² ² ² 7 GH GH GH GH 8 Tanner-Whitehouse-2 TW2 Greulich

33 & Pyle TW2 CASMAS Computer Aided Skeletal Maturity Assessment System 9 GH 1 1993 ICD-10 2 type IA IB type II 3SD GHRH GH GH IGF-1 IGFBP-3 3 6 ng/ml GHRP-2 16 ng/ml 4 3 GHD I GH GH II GH GH 5 6 1 3 5 6 SD catch up 1 III 1 kg 0.175 mg 6 7 IV GH 4 6 C 1

34 30 2 3 V VI 3 6 4 ml 1 1 1 TW2 SD SD VII GHD 1 TSH T4 GH GH T4 T4 2 ACTH 3 4

35 30 1 QOL 2 3 1 cm/ 4 5 1 GH IGF-1 2SD IGF-1 GH

36 30 GH QOL / 1 PIT-1 GH QOL 1-3 I 1 2 2 3 II 1 GH GHRP-2 4 5 6 1 120 180 30 GH 3 ng/ml 5 6 2 GHRP-2 60 15 GH 9 ng/ml ( 5 6 7 2 GH 8 III IGF-1 9 1 I 1 2 II 1 2 GH 2 I 2 II 2 II 1 1 GH

37 GH 1 I 1 2 II 1 2 GH GH 1.8 ng/ml GHRP-2 9 ng/ml 2 I 2 II 2 II 1 1 GH GH 1.8 ng/ml GHRP-2 9 ng/ml GH 1 2 GH growth without GH 3 4 GH GHRP-2 L-DOPA GHRH 5 GH GH GH GH 6 GH 1 2 DDAVP 3 α- β- 4 7 GH GHRP-2 GH

38 8 GH 9 1 18 18 2 GH GH GH 3 GHGH GH I GH GH QOL GH GH GH GH GH GH GH GH GH II GH GH GH 3 μg/kg / IGF-1 4 IGF-1 GH 1 mg/ GH 1 kg GH IGF-1 2 QOL GH III GH

39 1 GH T4 2 3 IGF-1 GH 4 GH 1 2 IGF-1 GH 24 4 1 12 24 1

40 ACTH 30 ACTH I 1 2 3 4 5 6 7 8 II 1 1 2 3 ACTH 2 4 ACTH CRH 100 μg 3 4 ACTH 5 5 ACTH 250 mg ACTH-Z Z 500 mg 3 III ACTH I 1 II 1 4 II 5 1 10 2 ACTH 10 pg/ml ACTH ACTH CRH ACTH 3 18 μg/dl CRH ACTH ACTH 4 45 mg/dl 0.1 U/kg 0.05 U/kg

41 18 μg/dl 5 ACTH CRH 1 ACTH CRH ACTH ACTH ACTH ACTH ACTH I II 1 1 2 1 2/3 1/3 ACTH 5 10 mg/ 1 2 10 20 mg/ 1 2 10 mg/ 7.5 mg 2.5 mg 15 mg/ 10 mg 5 mg 20 mg/ 15 mg 5 mg 2 3 kg 0.12 mg 3 2 1 3 III 1 2 3 3 200 mg/ 100 mg 100 mg /24 1 2

42 3 ACTH

43 PRL 30 PRL I II 1 PRL 1 2 TRH TRH 200 500 μg PRL 2 I II 1 2 PRL TRH PRL PRL

44 30 I 1 15 14 2 3 4 II 1 LH FSH 2 LHRH 3 III Kallmann Kallmann MRI IV 1 I II 2 Kallmann LHRH

45 I hcg-rfsh hmg hcg hcg-rfsh hcg-rfsh II 1 1 12.5 25 mg/ 4 3 6 250 mg/ 4 2 2 125 mg/ 2 3 250 mg/ 3 4 2 hcg- rfsh hmg 1 hcg 125 250 1 2 2 rfsh 37.5 1 2 1 2 hcg 1,500 3,000 / 2 rfsh 75 150 / 2 hmg 75 150 / 2 hcg-rfsh 3 300 ng/dl hcg 5,000 / rfsh hmg 75 150 3

46 III 11.5 hcg-rfsh

47 I 9.5 2 12 14 10 15 cm 145 cm 2.5SD 135 cm II 17β IGF-1 0.09 mg/ 2 1/2 0.045 mg 3 6 0.09 0.18 0.36 mg/2 2 0.09 0.18 mg/2 0.09 mg 1/4 1/8 3 6 2 III

48 1 2 I 1 2 6 1 10 7 2 14 14 7 II 1 2 1 5 50 100 mg/ 5 5 2 Ovarian hyperstimulation syndrome OHSS

49 5 7 FSH hmg FSH rfsh 1 50 225 hcg 5,000 10,000 hcg FSH 17 mm hcg 16 mm 4 hcg 1 2

50 TSH 30 TSH I 1 1 2 3 4 5 6 II 1 T4 2 2 TSH 3 3 4 TRH 200 500 μg TSH 4 1 2 5 III TSH nonthyroidal illness low T3 2 I 1 II 1 2 3 I 1 II 1 2 4 1 2) II 1 2 1 2 T3 T4 nonthyroidal illness low T3 T4 TSH 3 TSH TSH TRH T3 120 TSH 4 5 TRH 1 TRH TSH TRH

51 TSH I II L-T4 T4 TSH 12.5 25 μg 1 1 2 2.5 μg/kg 1 L-T4 T3 T3 1 10 25 μg 2 3 1 2 1 μg/kg 2 3 III 1 TSH L-T4 5 10 μg/ 1 2 TRH TSH

52 30 CT MRI 1 1 2 I 3 II III 1 MRI 2 MRI 4 3 1 2 3 3 6 1 MRI MRI 4 5 1 GH IGF-1 PRL TSH FT4 ACTH LH FSH E2 2 3 4 IC

53 5 GH GH IC GH 1 IgG4

54 30 1 IgG4 I 1 2 3 II 1 2 3 4 III 1 1 2 3 4 5 6 7 IgG4 2 1 2

55 3 4 5 I 1 2 II 1 1 2 3 4 MRI 1 5 2 III 1 2 3 4 5 empty sella I II I II 1 2 3 4 1 2

56 I II 1 2 3 MRI 4 III 1 2 I II I II 1 2 3

57 I 1 2 II 1 1 2 3 1 4 5 MRI 6 2 III 1 2 I 1 2 II I 1 2 II 1 2 3 4 5 1 2

58 1 0.5 1.0 mg/kg/ 2 3 MRI 4

59 IgG4 30 IgG4 I 1 2 II 1 1 2 3 1 4 5 IgG4 2 6 IgG4 3 7 IgG4 4 III 1 2 4 I II 1 2 4 6 II 3 4 6 I II 1 2 4 7 II 3 4 7 I II 1 2 4 5 II 3 4 5 1 2 135 mg/dl IgE 3 IgG4 10/HPF IgG4/IgG 40 4 IgG4 IgG4 IgG4 http //www.nanbyou.or.jp/entry/4505

60 COI 2 COI COI JCR