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Intraday and day to day variation in symptoms and severity of GDD

Intraday and day to day variation in symptoms and severity of GDD is common. Disease often has diurnal variation (varying of severity of the symptoms over the course of the day) is very common. Actually diurnal variation may be most common. It turns out that perhaps virtually all physiologic functions show diurnal variation. Diurnal variation in hormone release has been known for decades. Other variations such as sCr (and by extension eGFR) only recently has been recognized. Tangentially, this is also why I recommend 24 hr urine Gd, because diurnal variation is certain to exist, but it is not clear at what times of the day Gd release from tissues and elimination in urine is highest, so sampling the entire 24 hour period makes the most sense.

Diurnal variation may follow variation in certain hormones or activity level of host immune cells.

Variations over a longer wave length of variation, days to weeks seem also to occur with some frequency, This may reflect broader variations. It would seem reasonable to assume, as females hormonal follow a monthly pattern of hormones, why shouldn't GDD itself follow a broader variation in severity. Perhaps osteoclastic activity as the stimulating factor for increased symptoms by the increased release of Gd from bone. Why shouldn't osteoclastic activity be tied in with certain hormone status or other cell humoral product.

Even though men do not have as clearly defined monthly variation in hormones, why shouldn't broad wavelength hormone (or other humoral cell products) fluctuations also occur in men.

So diurnal variation of GDD exists, and is well explained, because essentially everything else has diurnal variation in the body. Broad wave length variation over a period of days or weeks can also be understood, although the mechanism in females seems obvious, as they already experience obvious monthly variation; 1 month intervals in men, my opinion is that it does exist, is not as well understood.

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Richard Semelka, MD. Consulting

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