Hypothalamic-pituitary function in uraemia

Abstract

Abstract. In a study of 221 patients with progressive uraemia and after successful renal transplantation, all patients had normal levels of plasma 11-hydroxycorticosteroids and sex hormone binding globulin (SHBG). Concentrations of T4 and Ts fell significantly (P < 0.005) with progressive uraemia whilst TSH remained normal. Levels of gonadal steroids also fell significantly (P < 0.0005) and in some patients there was gonadal failure with LH and FSH > 50 U/l; in the remainder, there was a modest increase in LH and minor increase in FSH as renal function deteriorated. Elevated Prl concentrations (P < 0.005) occurred even in moderate chronic renal failure and levels rose with progressive uraemia. In patients on maintenance haemodialysis, TSH response to thyrotrophin releasing hormone (TRH) was significantly blunted (P < 0.01) at 20 min but showed a late rise at 60 min; basal levels of GH were elevated in 27% and there was a heterogeneous GH response to TRH; LH response to gonadotrophin releasing hormone (GnRH) was normal whilst response of FSH was significantly blunted (P < 0.01). Irrespective of basal Prl level, there was a grossly blunted Prl response to TRH and metoclopramide (MCP) and no suppression of Prl after acute administration of i.-dopa or bromocriptine. Following successful renal transplantation, endocrine status was entirely normal. It is concluded that gross biochemical endocrine abnormalities arise with progressive uraemia, which are not ameliorated by maintenance haemodialysis but are abolished by successful transplantation. There is evidence of both hypothalamic and pituitary dysfunction contributing to these anomalies, which may be sensitive indices of non urea and creatinine related uraemic toxicity, and whose significance requires further evaluation.