Auswirkungen einer langdauernden exogenen Gonadotropinzufuhr auf die testikul�re Insuffizienz bei Dauerdialysepatienten

Abstract

Thirtheen male patients with chronic renal failure undergoing regular dialysis treatment (2 X 8-10 hours/week) were treated with gonadotropins (HCG, Primogonyl) primarily 2 X 2,000 IU/week and later 2,000 IU/week. Before HCG administration and during 4-months HCG-therapy testosterone, dihydrotestosterone, Androstandiol, LH and FSH levels were determined by RIA-methods in 7-14 days intervals. Before HCG-application plasma testosterone levels were low and did not increase in the course of regular dialysis treatment. Derivates from testosterone like dihydrotestosterone and Androstandiol were elevated in plasma, presumbably because of accumulation in renal failure. LH-levels were slightly elevated on the average. FSH-levels showed a high individual variation but also seemed to be elevated on the average. HCG stimulation by exogenous HCG administration for short time resulted in a insufficient rise of testosterone levels as compared to normals. During prolonged HCG administration plasma testosterone levels increased to normal but dropped immediatly after cessation of therapy or reduction to less than 2,000 IU HCG twice/week. Body weight, plasma proteins, haematocrite and fertility did not improve significantly. These results indicate that in chronic renal failure androgen synthesis by testicular tissue is seriously impaired and does not improve under usual dialysis treatment. Feedback regulation of testosterone levels by increase of LH levels seems not to be sufficient although pituitary response is found to be normal. This may be explained by elevated levels of testosterone derivates which exert negative feedback effects.

Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options

“…It is, therefore, not surprising that acute exogenous administration of human chorionic gonadotropin (hCG) is accompanied by a low testosterone response in dialysis patients (48,122,123). However, some authors have reported that prolonged HCG administration is followed by normalization in plasma testosterone levels, but that these levels decrease immediately after cessation of therapy or dose reduction to less than 2,000 IU HCG twice a week (123).…”

Investigation of the Hormonal Axis Hypothalamus-Pituitary-Gonads in 20 Dialyzed Men

“…The elevation of basal levels of LHmuch more striking than for FSHappears, therefore, not necessarily correlated to a manifest damage of the Leydig cells. This is surprising since elevated levels of LH are probably the most consistent finding in dialyzed patients (Holdsworth et al -1977;Sy Lim and Fang -1975;Bundschu et al -1976;Hrubesch et al -1973;Bundschu et al -1974;Heinrichs et al -1974).…”

“…Introduction ment of the male gonads in patients maintained on hemodialysis (Holdsworth et al -1977;Sy Lim and Fang -1975;Bundschu et al 1976). Further, virtually all investigators have reported low plasma testosterone levels in these patients (Holdsworth et al -1977;Sy Lim and Fang -1975;Bundschu et al -1976;Hrubesch et al 1973;Guevara et al -1969;Chen et al -1970;Gupta et al -1975;Zadeh et al -1975;.…”

“…In contrast, there is no definite evidence for an affection of the hypothalamic-pictuitary-system in patients on maintenance hemodialysis. While most studies demonstrated an intact re-action of the hypothalamus and/or the pituitary to stimulation and/or suppression (Holdsworth et al -1977;Sy Lim and Fang -1975;Bundschu et al 1976;Hrubesch et al -1973;Bundschuh et al -1971;Mies et al -1975;Bundschu et al -1974;Bindeballe et al -1973), "some degree of pituitary insensitivity" (Holdsworth et al -1977) as well as "heightened sensitivity of the hypothalamus" (Sy Lim et al -1975) have been suggested.…”

Ultrastructure of the Rat Testis in Experimental Uremia

“…In view of raised LH levels in uremic man (Bundschu et al -1976) and uremic animals (Kreusser et alin press), the ultrastructural evidence of low basal Leydig cell activity, which can be restored by high doses of hCG, points to gonadal endorgan resistance in uremia. The concept of endorgan resistance was originally proposed on the basis of measurements of the interaction between LH and testosterone levels in uremic man (Bundschu et al -1976); this notion is also supported by recent findings in our laboratory that the dose-response-curve for testicular CAMP content in response to LH is shifted to the right in uremic animals (Kreusser et alin press). The finding in uremic animals of abnormal Sertoli cell ultrastructure which is partially responsive to hCG is compatible with inappropriately low local testosterone concentrations in uremic animals and these may be responsible for abnormal ultrastructure of the germinal epithelium.…”