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Pulsatile growth hormone secretion in peripubertal patients with chronic renal failure. Cooperative Study Group on
F Schaefer1, G Hamill, R Stanhope
1Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Insights
Growth hormone (GH) secretion patterns during puberty differ in children with chronic kidney disease. Transplantation may normalize GH levels but can lead to growth failure due to steroid effects.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Hormone Physiology
Background:
- Pubertal growth is linked to pulsatile growth hormone (GH) secretion.
- Abnormalities in GH regulation are noted in chronic renal failure (CRF).
Purpose of the Study:
- To examine GH pulsatility in pubertal patients with CRF.
- To correlate GH secretion with pubertal growth across different treatment modalities.
Main Methods:
- Studied spontaneous nighttime GH profiles in 80 pubertal patients (10-20 years) with CRF.
- Patients were grouped by conservative treatment, dialysis, or post-renal transplantation.
- Analyzed GH pulsatility using the PULSAR algorithm.
Main Results:
- GH levels and pulse amplitudes were higher in conservative/dialysis groups than post-transplant.
- GH levels were lowest in late puberty, with a blunted midpubertal GH amplitude increase post-transplant.
- GH levels correlated with androgens in boys; peak amplitude correlated with height velocity post-transplant.
Conclusions:
- GH secretion is altered in CRF, with potential end-organ hyporesponsiveness.
- Growth failure post-transplantation may stem from steroid-induced GH hyposecretion.
Abstract:
The pubertal growth spurt has been associated with changes of physiologic pulsatile growth hormone (GH) secretion, and abnormalities of the central regulation of GH release have been found by pharmacologic testing in patients with chronic renal failure. To assess the characteristics of GH pulsatility in chronic renal failure and their relationship to pubertal growth, we studied spontaneous nighttime GH plasma profiles in 80 patients (61 boys) aged 10 to 20 years receiving conservative treatment (n = 29) or dialysis (n = 18) or after renal transplantation (n = 33). Tanner genital stages 1 to 4 in boys and breast stages 1 to 3 in girls were represented. Growth hormone pulse analysis was performed by the PULSAR algorithm. Growth hormone concentration profiles were pulsatile in each patient. Growth hormone mean and baseline levels and pulse amplitudes were higher in patients receiving conservative or dialysis treatment than in patients who had undergone renal transplantation. Peak frequency was similar in all treatment groups in boys but higher in girls who had undergone transplantation than in girls receiving conservative or dialysis treatment. Growth hormone peak amplitude and mean levels were lowest in patients in late puberty. The physiologic elevation of GH amplitudes around midpuberty was observed in boys receiving conservative and dialysis treatment but not after transplantation. Growth hormone mean and baseline levels were positively correlated with plasma androgen levels in boys. Growth hormone peak amplitude was correlated with 6-month height velocity after transplantation but not in patients receiving conservative treatment or dialysis. A strong inverse relationship was observed between GH peak amplitude and corticosteroid dosage in patients undergoing transplantation. The lack of relationship between circulating GH levels and growth in patients receiving conservative or dialysis treatment is compatible with end-organ hyporesponsiveness to GH. Pubertal growth failure despite successful transplantation appears to be related to steroid-induced GH hyposecretion.