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Delayed puberty in uremia: Pituitary-gonadal function during short-term pulsatile luteinizing hormone-releasing hormone administration

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Abstract

Pubertal development is frequently delayed or disordered in children with chronic renal failure. Both neuroendocrine and peripheral alterations due to uremia have been hypothesized to explain the impairment in the pituitary gonadal axis. The aim of the present study was to evaluate quantitative (immunological) and qualitative (biological) LH secretion, as well as FSH and sex steroids, before and during 7 days of sc LHRH administration (136–150 ng/kg bw every 120 min) in 5 uremic children (13.1–14.8 yr) with delayed puberty. Six nonuremic children (13.2–17.8 yr) with delayed puberty underwent the same schedule and served as control group. On day 0 mean immunoreactive LH (l-LH) levels were higher in uremic (4.5±0.9 mlU/ml) than in nonuremic (1.9±03 mlU/ml; p<0.05) subjects while no differences were observed in bioactive LH (B-LH) levels (2.9±0.7 mlU/ml vs 2.4±0.3 mlU/ml). In both groups of subjects testosterone was at prepubertal levels. Spontaneous l-LH and B-LH pulses were observed sporadically in both uremic and nonuremic subjects. Short-term pulsatile LHRH ad-ministration induced significant increases in B-LH, I-LH, FSH and testosterone. The B/l LH ratio increased from day 0 (0.7±0.2) to day 7 (1.310.4; p<0.05) in uremics while it showed wide fluctuations in nonuremic subjects. On day 7, 4 uremic and 5 nonuremic subjects showed a pulsatile release of B-LH after exogenous LHRH pulses. Our data document that in uremia there are qualitative as well as quantitative abnormalities in pituitary gonadal secretion. Seven days of pulsatile LHRH administration seems to partially reverse the impaired activity of the pituitary gonadal axis. Uremic and nonuremic subjects showed the same responsiveness to the LHRH administration. A disturbed endogenous LHRH discharge could be hypothesized in delayed or disordered puberty in uremic children, as has already been suggested in nonuremic children with delayed puberty.

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Authors and Affiliations

  1. DISEM, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy

    Massimo Giusti M.D. (Cattedra di Endocrinologia), D. Cavallero (Cattedra di Endocrinologia), S. Valenti (Cattedra di Endocrinologia) & G. Giordano (Cattedra di Endocrinologia)

  2. Divisione Nefrologica e Dialisi, Istitute Gaslini, Genova, Italy

    F. Perfumo, E. Verrina, G. Piaggio & R. Gusmano

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  1. Massimo Giusti M.D.
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Giusti, M., Perfumo, F., Verrina, E. et al. Delayed puberty in uremia: Pituitary-gonadal function during short-term pulsatile luteinizing hormone-releasing hormone administration. J Endocrinol Invest 15, 709–717 (1992). https://doi.org/10.1007/BF03347637

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