Pituitary-testicular axis in children with chronic renal failure on hemodialysis

Abstract EN

Chronic renal failure (CRF) is used to describe a patient who has residual renal function of less than 30%, defined as progressive and irreversible deterioration in renal function.

The hypothalamo pituitary-testicular axis, is susceptible to significant pathophysiological alterations in CRF, which may lead to delayed bone age and impeded or arrested pubertal maturation. Aim: the objective of this study is to evaluate the pituitary-gonadal axis in male children with CRF on hemodialysis therapy. Methodology: The study was conducted in Department of Nephrology, Pediatric Hospital, cairo University and included 19 male patients more than10 years old with ESRD, on regular hemodialysis.

It included also 20 age matched healthy individuals as a control group.

Patients were subjected to history taking, clinical examination including pubertal assessment by Tanner's classification of puberty and laboratory investigations including kidney function tests, complete blood count and serum albumin, basal levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and prolactin.

LHRH stimulation was done, then peak level of both LH and FSH is measured after 4 hours.

Result: Delayed puberty was found among 68.4% of patients with CRF.

No significant correlation was found between hormonal data and anthropometric measurements in the studied patients.

Serum testosterone level was found significantly lower in patients than in controls, but no correlation was found between it and serum creatinine or (Kt / V).

LH peak and LH / FSH peak was found lower in patients than controls, while serum prolactin levels were significantly higher.

LH peak and serum testosterone had positive correlation with hemoglobin & hematocrit level, while only LH peak was correlated to serum albumin. Conclusion: In CRF pubertal development is delayed and is associated with decreased testosterone levels together with impaired regulation of gonadotropin secretion and a peripheral resistance to hormonal action.

The efficiency of dialysis has a role in normalization of pituitary-gonadal axis.

Nutritional status is important for pituitary-gonadal function.