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It binds the GHRH receptor (GHRHR) on somatotroph cells of the anterior pituitary, activating adenylyl cyclase, raising intracellular cAMP, and triggering pulsatile growth hormone secretion

Dermoscopy may show brown or black globules, homogeneous or irregular lines, zigzag lines, proximal periungual pigmentation resembling Hutchinson sign, and distal fibrillar brush pigmentation (Fig

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2d, Supplementary Fig