Hypothalamic-pituitary function in uraemia

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Abstract
In a study of 221 patients with progressive uremia and after successful renal transplantation, all patients had normal levels of plasma 11-hydroxycorticosteroids and sex hormone binding globulin (SHBG). Concentrations of thyroxine and triiodothyronine fell significantly (P < 0.005) with progressive uremia while TSH remained normal. Levels of gonadal steroids also fell significantly (P < 0.0005) and in some patients there was gonadal failure with LH [lutropin] 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 [prolactin] concentrations (P < 0.005) occurred even in moderate chronic renal failure and levels rose with progressive uremia. In patients on maintenance hemodialysis, TSH response to TRH was significantly blunted (P < 0.01) at 20 min but showed a late rise at 60 min; basal levels of GH [growth hormone] were elevated in 27% and there was a heterogenous GH response to TRH; LH response to gonadotropin releasing hormone (GnRH) was normal while 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 and no suppression of Prl after acute administration of L-dopa or bromocriptine. Following successful renal transplantation, endocrine status was entirely normal. Gross biochemical endocrine abnormalities evidently arise with progressive uremia, which are not ameliorated by maintenance hemodialysis 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 uremic toxicity, and whose significance requires further evaluation.