Influence of Type of Immunosuppressive Therapy on Secretion of Somatotropin and Function of the Pituitary-Adrenal and Pituitary-Gonadal Axis in Patients with a Kidney Transplant

Nieszporek, Teresa; Grzeszczak, W; Kokot, F; Żukowska-Szczechowska, E; Kuśmierski, S; Szkodny, A

doi:10.1159/000185704

Cited by 18 publications

(12 citation statements)

References 7 publications

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“…Data shows that patients with AIDS frequently have abnormal blood cortisol levels and that their adre nals respond subnormally to ACTH stimulation [33][34][35][36]. Adrenal dysfunction has also been reported in other types of secondary immune deficiency, such as that related to cyclosporin treatment [37]. Thus, patients receiving cy closporin had decreased serum cortisol levels, as well as a diminished response to hypoglycemia, despite normal or even higher plasma ACTH levels.…”

mentioning

confidence: 99%

Impaired Hypothalamo-Pituitary-Adrenal Axis Function in Swiss Nude Athymic Mice

Daneva¹,

Spinedi²,

Hadid³

et al. 1995

Neuroendocrinology

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Various evidence suggests a bidirectional circuit between the immune and neuroendocrine systems. Because of the well-known role of the thymus in the regulation of the immune function, we designed this study to determine whether the lack of thymus may affect hypothalamo-pituitary-adrenal (HPA) axis activity by using both in vivo and in vitro paradigms in Swiss nude (athymic) and BALB/c (normal) mice. Eight-week-old female mice of both strains were used to study: (a) the in vivo response of the HPA axis to various stress stimuli acting at either hypothalamic (ether vapor inhalation, insulin administration), pituitary (CRH injection) or adrenal (ACTH treatment) level and (b) the in vitro response of pituitary and adrenal cells to CRH and ACTH stimulation, respectively. The results indicate that: (1) basal plasma ACTH levels were significantly (p < 0.05) higher in Swiss nude than in BALB/c mice, whereas basal plasma corticosterone (B) concentrations were similar in both strains of mice; (2) the stress-induced release of ACTH and B in plasma were significantly (p < 0.05) lower in Swiss nude than in BALB/c mice, regardless of the stimulus applied; (3) the in vitro pituitary response to CRH and the adrenal response to ACTH were significantly (p < 0.05) lower in Swiss nude than in BALB/c mice, whereas (4) hypothalamic CRH and pituitary ACTH contents were similar in both strains, adrenal B concentration was significantly (p < 0.05) lower in athymic mice; in addition, the nude mice adrenal glands were larger than those of BALB/c animals, due to marked hypertrophy of the zona fasciculata. In conclusion, our results indicate that athymic nude mice have a blunted HPA axis response to various stress stimuli; this defect seems to reside at both the pituitary and adrenal levels. It remains to be determined whether this impairment is directly related to the immunodeficiency of this animal model.

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mentioning

confidence: 99%

Impaired Hypothalamo-Pituitary-Adrenal Axis Function in Swiss Nude Athymic Mice

Daneva¹,

Spinedi²,

Hadid³

et al. 1995

Neuroendocrinology

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“…As KTP are usually treated by pharma cological doses of prednisone, rather sup pressed basal plasma ACTH and cortisol lev els may be expected. In fact, ACTH secretion does not seem to be altered in KTP in spite of significantly reduced plasma cortisol lev els both under baseline and stimulatory con ditions [31]. In contrast to normals, the cor tisol response to hypoglycaemia is com pletely blunted in KTP, irrespective of the kind of immunosuppressive therapy [31], Significantly lower plasma cortisol levels were found in CS-A-than in azathioprinetreated patients [31], The dissociation of the pituitary-adrenal feedback is not clear and remains to be elucidated.…”

Section: Adrenocorlicotrophic Hormone (Acth)-cortisol Axismentioning

confidence: 82%

“…and CS-A. respectively [31]. To our knowledge, no data are avail able on plasma IGF I and II levels in KTP.…”

Section: Pituitary Gland Somatotrophin (Sth)mentioning

confidence: 89%

“…In spite of abnormally elevated plasma STH levels, suppressed plasma levels of somatomedin (IGF) I but elevated con centrations of IGF II have been reported. After successful kidney transplantation plasma STH levels are usually in the normal or upper normal range [31,32], Insulininduced hypoglycaemia is followed by a sig nificant increase of plasma STH levels which is markedly lower in azathioprine -than CS-A-treated patients and in normals [31]. No correlation was found between the hypoglycaemia-induced STH and cortisol reaction pattern and the dose of administered predni sone, azathioprine.…”

Section: Pituitary Gland Somatotrophin (Sth)mentioning

confidence: 95%

“…In patients with a well functioning renal transplant, basal plasma ACTI-I levels are not different from normals [31 ]. In KTP a normal (in patients treated by azathioprine) or an exaggerated (in CS-Atreated subjects) response of plasma ACTH to insulin-induced hypoglvcaemia was found [31 ]. As KTP are usually treated by pharma cological doses of prednisone, rather sup pressed basal plasma ACTH and cortisol lev els may be expected.…”

Section: Adrenocorlicotrophic Hormone (Acth)-cortisol Axismentioning

confidence: 96%

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Endocrine Alterations in Kidney Transplant Patients

Kokot¹,

Grzeszczak²,

Żukowska-Szczechowska³

et al. 1990

Blood Purif

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Several factors are involved in the persistence of endocrine alterations after renal transplantation, among which the following are to be mentioned: (1) duration of chronic uraemia before renal transplantation; (2) residual function of the patients’ native kidneys; (3) quality of function of the renal graft; (4) modulation of secretion, transport, and degradation of hormones, and/or (5) altered target organ responsiveness to hormones induced by immunosuppressive drugs (glucocorticoids, azathioprine, cyclosporin A) or altered internal environment. In kidney transplant patients the following endocrine abnormalities are to be mentioned: dissociation of the physiological relationship between aldosterone synthesis and function of the renin-angiotensin system, abnormal volumetric regulation of arginine vasopressin secretion, suppressed responsiveness of cortisol secretion to stimulatory manoeuvres, persistent secondary hyperparathyroidism, relative deficiency of insulin (induced by glucocorticoid therapy), with consequent carbohydrate intolerance or even diabetes mellitus, suppressed response of gastrin and pancreatic hormone secretion to a test meal, and reduced responsiveness of atrial natriuretic peptide secretion to central hypervolaemia. Episodes of acute graft rejection are characterized by endocrine alterations similar to those seen in patients with acute or chronic renal failure.

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Growth after conversion to alternate-day corticosteroids in children with renal transplants: a single-center study

et al. 1994

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During the 1980s all children with growth potential and stable/adequate renal function at 6-9 months after kidney transplantation underwent conversion to alternate-day corticosteroids in an attempt to maximize growth. Conversion was attempted in 79 of 160 children who received allografts during this decade and was considered successful if they remained on alternate-day prednisone for more than 1 year, with a calculated creatinine clearance of at least 75% of the pre-conversion baseline value. Conversion succeeded in 55 children but failed in 24. Growth was markedly improved among those successfully converted when compared with the failure group, as measured by standard deviation score for growth velocity based on chronological age (+0.94 +/- 1.58 vs. -0.86 +/- 1.53, P < 0.001) and bone age (+0.49 +/- 0.61 vs. -1.24 +/- 1.47, P < 0.001). The improved growth among the successfully converted patients is believed to have been related to the combined effects of lower corticosteroid dose (0.36 +/- 0.16 vs. 0.48 +/- 0.21 mg/kg per day, P < 0.02) and better renal function (calculated creatinine clearance 87 +/- 32 vs. 47 +/- 21 ml/min per 1.73 m2, P < 0.001) at 1 year post conversion. Two factors appeared to improve the likelihood of successful conversion: the use of cyclosporine and receiving a live-related rather than cadaver transplant. Cyclosporine was associated with improvement in the overall rate for successful conversion in all recipients, from 59% to 83% (P < 0.05). Recipients of allografts from live-related donors underwent successful conversion in 90% of cases compared with 58% receiving cadaver allografts (P < 0.05). (ABSTRACT TRUNCATED AT 250 WORDS)

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Influence of Type of Immunosuppressive Therapy on Secretion of Somatotropin and Function of the Pituitary-Adrenal and Pituitary-Gonadal Axis in Patients with a Kidney Transplant

Cited by 18 publications

References 7 publications

Impaired Hypothalamo-Pituitary-Adrenal Axis Function in Swiss Nude Athymic Mice

Impaired Hypothalamo-Pituitary-Adrenal Axis Function in Swiss Nude Athymic Mice

Endocrine Alterations in Kidney Transplant Patients

Growth after conversion to alternate-day corticosteroids in children with renal transplants: a single-center study

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