Pulsatility of luteinising hormone in men with chronic renal failure: abnormal rather than absent.

Wheatley, Trevor; Clark, P. M. S.; Clark, J. David; Raggatt, P R; Evans, David B.; Holder, Roger

doi:10.1136/bmj.294.6570.482

Cited by 22 publications

(9 citation statements)

References 4 publications

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“…We have found elevated levels of immunoreactive gonado trophins in men undergoing haemodialysis, whereas To levels were normal. These data are in agreement with other recent studies [10,II], This dysfunction of the hypo thalamic-pituitary-testicular axis could be explained by an abnormality in the pulsatile secretion o f LH and/or changes in the biopotency of LH and we have found evidence for both of these mechanisms. LH of reduced biopotency was observed in subjects undergoing dialysis and B-LH pulses were not detectable in 2 of the subjects.…”

Section: Discussionsupporting

confidence: 83%

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Pulsatile Bioactive Luteinizing Hormone Secretion in Men with Chronic Renal Failure and following Renal Transplantation

Talbot

Rodger

Robertson

1990

Nephron

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We have measured plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (To) by radioimmunoassay (RIA) and bioactive LH (B-LH) by in vitro bioassay at 10-min intervals over 6 h in men treated by haemodialysis for renal failure and in men after renal transplantation. Eleven normal male volunteers acted as controls. Immunoreactive LH (I-LH) and FSH levels were elevated (p < 0.03) in uraemia (mean ± SE; 10.0 ± 1.0 and 4.6 ± 0.7 IU/l for LH and FSH, respectively) and following renal transplantation (8.1 ± 1.2 and 5.3 ± 0.5 IU/l) compared to controls (C) (4.9 ± 0.5 and 2.7 ± 0.4 IU/l) whereas B-LH [17.3 ± 2.5, 14.8 ± 1.8 and 12.9 ± 1.3 IU/l in dialysis (D), transplant (T) and C groups, respectively] levels were normal. Prolactin levels were elevated (p < 0.03) in the D group (median 348, range 162–1,780 mU/l) compared to the T group (161, 91–206 mU/l) and controls (163, 124–312 mU/l) whereas total To levels (mean ± SE; 17.3 ± 4.8,15.5 ± 1.3 and 19.6 ± 2.1 nmol/l in the D, T and C groups, respectively) were similar as was the free To index. B-LH (median frequency, 2 and range 1–3 pulses/6 h) and I-LH (median frequency, 2 and range 1–2 pulses/6 h) was pulsatile in all the C group but B- and I-LH pulses were absent in 2 of the 5 subjects treated by dialysis. Following renal transplantation B-LH pulses were detected in all subjects, whilst I-LH pulses were absent in 1 subject. I-LH pulse frequency (median 1, range 0–1 pulse/6 h) was reduced (p < 0.03) in the D and T groups. B-LH pulse frequency was normal in the D group (median 1, range 0–2 pulses/6 h) but reduced in the T group (1,1–2 pulses/6 h). B :I LH ratios were decreased (p < 0.03) in the D and T groups (median and range; 1.7,1.27–2.46 and 2.05,1.52–2.88, respectively, compared to normal controls – (2.49, 2.04–3.49). The mean B:I LH ratio was correlated with mean To levels in the D group only (r = 0.93, p < 0.01). In conclusion, LH pulsatility is abnormal in uraemia and renal transplantation only partially reverses this condition.

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Section: Discussionsupporting

confidence: 83%

“…Little is known of LH pulsatility in uraemia but two recent studies on I-LH pulsatility have indicated that it is reduced [10] or absent [11]. After renal transplantation l-LH pulsatility returned to normal [11].…”

Section: Introductionmentioning

confidence: 99%

Pulsatile Bioactive Luteinizing Hormone Secretion in Men with Chronic Renal Failure and following Renal Transplantation

Talbot

Rodger

Robertson

1990

Nephron

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“…Androgen deficiency in men with end-stage kidney disease (ESKD) is common and results from abnormalities at all levels of the hypothalamic-pituitary testicular axis [1,2,3,4,5]. Previous studies suggested that the above deficiency is implicated in the pathogenesis of reduced muscle mass (sarcopenia), infertility, gynecomastia and sexual dysfunction in these patients [6,7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

Karakitsos

Patrianakos²,

Groot

et al. 2006

Am J Nephrol

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Objectives and Methods: Two thirds of men with end-stage kidney disease (ESKD) have serum testosterone levels in the hypogonadal range. We examined if low serum testoster- one levels were correlated with measures of endothelial dysfunction in ESKD. Bilateral common carotid artery (CCA) intima-media thickness (IMT) and atherosclerotic plaque occurrence, left ventricular mass index, flow- (FMD) and nitrate-mediated vasodilatation (NMD) of the brachial artery were determined by ultrasound imaging in 100 nondiabetic men with ESKD (50 men exhibited androgen deficiency; serum testosterone concentrations <300 ng/dl). Results: Left-ventricular mass index, CCA diameter, CCA-IMT and atherosclerotic plaque occurrence were all significantly increased in ESKD patients with androgen deficiency compared with patients without androgen deficiency (p < 0.05). Also, FMD and NMD measurements were significantly reduced in the former compared with the latter (p < 0.05). Testosterone levels were inversely correlated with age and duration of hemodialysis therapy (r = –0.44 and r = –0.55; p < 0.001). Testosterone levels were negatively correlated to CCA-IMT and atherosclerotic plaque occurrence in patients with androgen deficiency (r = –0.32, p < 0.003, and r = –0.23, p < 0.04, respectively). FMD and NMD measurements were positively correlated to total (r = 0.65 and r = 0.61; both p < 0.0001) and free (r = 0.52 and r = 0.48; both p < 0.001) testosterone levels in patients with low androgenicity. Conclusion: The present results indicated that ESKD patients with androgen deficiency had increased CCA-IMT, atherosclerotic plaque occurrence and reduced FMD and NMD compared with patients without androgen deficiency. Testosterone serum levels were negatively correlated to CCA-IMT and positively correlated to endothelium-dependent vasodilatation in ESKD patients with androgen deficiency.

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“…Noxious effects of several uremic tox ins on the gonads, malnutrition, anemia, and vascular dis ease have been implicated in the origin of this alteration [3,4], Gonadotropin responses to gonadotropin-releasing hormone (GnRH) administration in uremic male patients have been found to be normal or impaired by some authors [9,10] or delayed and sustained by others [3,7,[11][12][13][14], this indicating some derangement at the hypotha lamic or pituitary levels. The abnormal pulsatilitv of LH found in hemodialized patients also suggests a hypothalamo-hypophyseal dysfunction [15][16][17][18],…”

Section: Introductionmentioning

confidence: 99%

Effects of Erythropoietin on Gonadotropin Responses to Gonadotropin-Releasing Hormone in Uremic Patients

Jj¹,

Iglesias

et al. 1997

Nephron

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Long-term therapy with recombinant human erythropoietin (rhEPO) in uremic male patients undergoing hemodialysis has been followed by an increase in plasma levels of testosterone and a decrease in baseline levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The aim of the present study was to assess the effect of acutely administered rhEPO on FSH and LH responses to gonadotropin-releasing hormone (GnRH) in a group of uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Sixteen clinically stable male patients (age, mean ± SEM, 45.3 ± 3.9 years) with chronic renal insufficiency and 12 healthy volunteers with a normal renal function, matched for age and body mass index, were studied. All patients were on CAPD therapy for at least 3 months, and none of them received rhEPO therapy. Patients were moderately anemic (hemoglobin 11.0 ± 0.3 g/dl) and showed testosterone levels significantly lower than those found in control subjects (3.47 ± 0.37 vs. 6.91 ± 0.49 ng/ml, p < 0.001). Each subject was tested with GnRH (100 μg i.v. as bolus) and with GnRH plus rhEPO (40 U/kg at a constant infusion rate for 30 min, starting 15 min before GnRH injection) on different days. Blood samples for FSH and LH were obtained between -30 and 120 min. In uremic patients the baseline FSH levels were higher than those found in control subjects (18.88 ± 5.41 vs. 6.41 ± 1.10 mU/ml, p < 0.05). After GnRH administration FSH values reached a maximum of 25.50 ± 6.19 mU/ml in patients and of 12.50 ± 2.02 mU/ml in controls (p < 0.05). rhEPO infusion produced a significant (p < 0.01) decrease in the area above the baseline value of FSH in uremic patients, with no other change in FSH responses to GnRH both in patients and controls. Baseline LH concentrations were significantly higher in patients than in controls(15.56 ± 3.41 vs. 2.58 ± 0.36 mU/ml, p < 0.001). LH peak and area under the curve of LH secretion after GnRH were significantly higher in patients than in controls (45.25 ± 6.28 vs. 26.83 ± 4.62 mU/ml, p < 0.05, and 77.02 ± 11.30 vs. 34.40 ± 5.22 mU·h/ml, p < 0.005, respectively). When GnRH was injected during the rhEPO infusion, a significant (p < 0.02) reduction in LH concentrations at 60, 90, and 120 min was found in uremic patients. Accordingly, the LH area under the curve was significantly reduced in patients (65.99 ± 11.44 mU·h/ml, p < 0.05). rhEPO had no effect on GnRH-induced LH release in control subjects. These results suggest that acute rhEPO administration might reduce the exaggerated LH response to GnRH stimulation found in uremic male patients on CAPD.

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Pulsatility of luteinising hormone in men with chronic renal failure: abnormal rather than absent.

Cited by 22 publications

References 4 publications

Pulsatile Bioactive Luteinizing Hormone Secretion in Men with Chronic Renal Failure and following Renal Transplantation

Pulsatile Bioactive Luteinizing Hormone Secretion in Men with Chronic Renal Failure and following Renal Transplantation

Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

Effects of Erythropoietin on Gonadotropin Responses to Gonadotropin-Releasing Hormone in Uremic Patients

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