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ACTH, in turn, activates the adrenal cortex, leading to the release of cortisol, the primary stress hormone (33)

Patients with primary carnitine deficiency lose most (1095%) of the filtered carnitine in urine, and their heterozygous parents lose 2 to 3 times the normal amount, explaining their mildly reduced plasma carnitine levels [3, 16, 82]

SCD is found in individuals with renal tubular diseases, where carnitine excretion may be high, as well as hemodialysis patients

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