Hormonal profile in pubertal females with chronic renal failure: Before and under haemodialysis and after renal transplantation

Abstract

The effects of chronic renal failure on the hypothalamic-pituitary-ovarian axis in 25 girls, aged 9.1 to 20.9 years (mean 13.8) were studied. Twelve patients on conservative treatment (group A) had serum creatinine values between 176.8 and 1502.8 \g=m\mol/l; 9 patients were on haemodialysis (group B); and 12 patients had received a renal transplant (group C). Tanner stage of breast development was delayed relative to chronological age in 5 out of 18 patients. Serum oestradiol was normal or low when related to pubertal stages in all groups. Serum LH was elevated in group A and B patients, but normal in group C patients. Serum FSH was elevated in 6 out of the 21 patients in group A plus B, and in 2 out of the 12 patients in group C. Serum PRL was elevated in 12/12, 6/8, and 4/11 patients in group A, B, and C respectively. After GnRH administration to 4 patients in group A, 3 showed delayed or absent gonadotropin response; all 4 patients studied in group C showed normal gonadotropin response. The data indicate a decreased E2 secretion, abnormal gonadotropin and PRL levels and a blunted gonadotropin response to GnRH in girls with chronic renal failure.These results seem to indicate an alteration of the hypothalamic-pituitary unit that can be reversed after successful renal transplantation.

Growth Retardation in Children with Kidney Disease

“…Finally, the plasma concentration of inhibin is elevated [21]. In females estradiol levels tend to decrease in proportion to the decrease in GFR [22]. …”

Pulsatile gonadotropin secretion in pubertal children with chronic renal failure

“…Earlier studies in prepubertal (Oertel et al 1983) and pubertal (Ferraris et al 1980(Ferraris et al , 1987 children with CRF have demonstrated an abnormal pitui¬ tary response to an intravenous bolus of high-dose GnRH, suggesting a hypothalamo-pituitary disor¬ der as the likely aetiology of delayed pubertal de¬ velopment. However, bolus GnRH tests are diffi¬ cult to interpret, due to elevated baseline serum LH levels and reduced metabolic clearance rates in CRF.…”

“…Children with CRF may have pubertal develop¬ ment which is delayed or disordered (Ferraris et al 1980(Ferraris et al , 1987Schärer et al 1976;Rizzoni et al 1986;van Diemen-Steenvorde et al 1987). Several endo¬ crine abnormalities such as low or subnormal gonadal steroids and elevated gonadotropin concen¬ trations in plasma have been reported in pre¬ pubertal (Oertel et al 1983) as well as in pubertal (Ferraris et al 1980(Ferraris et al ,1987 children with CRF.…”

“…Several endo¬ crine abnormalities such as low or subnormal gonadal steroids and elevated gonadotropin concen¬ trations in plasma have been reported in pre¬ pubertal (Oertel et al 1983) as well as in pubertal (Ferraris et al 1980(Ferraris et al ,1987 children with CRF. In ad¬ dition, delayed and blunted gonadotropin responses to intravenous administration of gonadotropin-releasing hormone (GnRH) have been dem¬ onstrated (Ferraris et al 1980(Ferraris et al , 1987Oertel et al 1983). Thus, primary gonadal dysfunction associ¬ ated with a disturbance at the pituitary level has been postulated as the aetiology of disorders of puberty occurring in CRF.…”

Perfil hormonal sexual de mulheres em programa crônico de diálise em tratamento com eritropoetina humana recombinante

“…Esse fato poderia explicar os níveis baixos de FSH, por um efeito de bloqueio do eixo hipotálamo-hipofisário determinado pelo contraceptivo. Neste grupo, houve concordância com a maior parte da literatura no tocante às dosagens de FSH, que se mostram dentro da normalidade; nas dosagens de LH, embora muitos autores relatem níveis elevados 26,23,31,36,37 , não encontramos nenhum valor acima do considerado normal. Também aqui houve uma paciente com níveis ligeiramente diminuídos: trata-se de portadora de lúpus eritematoso sistêmico submetida a corticoterapia crônica com prednisona.…”