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Regulation of Body Weight by Proopiomelanocortin Peptides in Humans: Lessons from the Nelson Syndrome

Rajagopal V. Sekhar, MD; J. Clay Goodman, MD; Ashok Balasubramanyam, MD; Jeffrey B. Tatro, PhD; and Emese Mihaly, PhD
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From Baylor College of Medicine, Houston, TX 77030; Tufts University School of Medicine, Boston, MA 02111; and Semmelwies University Medical School, 1088 Budapest, Hungary.

Editor's Note: The lead author of the following Clinical Observation was one of a dozen Associates of the American College of Physicians selected to present a clinical vignette at the 2003 Annual Session in San Diego. We are proud to present this case report through a special arrangement with the Council of Associates of the College.

Acknowledgment: The authors thank Margaret Entwistle for technical expertise.

Grant Support: By National Institutes of Health grants DK59537 and HL73696 to Dr. Balasubramanyam and grant MH44694 to Dr. Tatro.

Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2005;143(3):238-239. doi:10.7326/0003-4819-143-3-200508020-00021
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Inverse relationship of body weight and plasma adrenocorticotropic hormone (ACTH) levels or intensity of scar pigmentation as biomarker.
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Appendix Figure 1.
Dynamic changes of skin and scar pigmentation with fluctuations of plasma levels of adrenocorticotropic hormone.
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Appendix Figure 2.
Abdominal scars with variable pigmentation reflecting the plasma level of adrenocorticotropic hormone at the time of formation.

1 = laparotomy for gastric stapling (light scar); 2 = adrenalectomy (light scar); 3 = reversal of gastric stapling (dark scar); 4 = first hypophysectomy (dark scar); 5 = second hypophysectomy (dark scar).

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