Abstract
Delayed gonadal and/or adrenal puberty in children with ESRD diminishes patient self-esteem and hamper rehabilitation. Data detailing adrenal puberty in patients with ESRD are not available. For that reason 26 patients (16 male; 10 female) who were between 6.5 and 22.5 years of age (mean: 14.5) were studied. Ten patients were pre-pubertal, 8 pubertal and 8 post-pubertal. All of them were on chronic hemodialysis. The Tanner stages (pubic hair development) were delayed in 56% of patients. Serum cortisol (C) was increased in all, but 2 patients. Serum Δ4-androstenedione (Δ4) was normal in all but 2 patients. Serum dehydrcepiandrosterone sulfate (DS) was increased in 6 out of 11 pre-pubertal and pubertal males. Bone age showed a positive correlation with DS (r= 0.53; p<0.005). Serum ACTH was normal. A reduction of 50% in C and 78% in DS was found after dexamethasone suppression (DX); but Δ4 did not suppress post DX. ACTH stimulation test increased C by 50% and Δ4 by 80%, but no stimulation was observed in DS. CONCLUSIONS: In pediatric patients and young adults with ESRD, we found: 1) Increased C levels and partial DX resistance of pituitary-adrenocortical axis, similar to that found in Gushing's disease or in stress; 2) Delayed development of the androgen producing zona reticularis, suggested by the lack of response of DS to ACTH; 3) The dissociation between C and adrenal androgens observed is consistent with the existence of different mechanisms of control for these two adrenal functions.
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Ferraris, J., Ramirez, J., Goldberg, V. et al. GLUCOCORTICOIDS AND ADRENAL ANDROGEN FUNCTION IN PEDIATRIC PATIENTS WITH END STAGE RENAL DISEASE (ESRD). Pediatr Res 22, 370 (1987). https://doi.org/10.1203/00006450-198709000-00040
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DOI: https://doi.org/10.1203/00006450-198709000-00040