Hypogonadism, a serious complication of chronic renal insufficiency

Česká verzia

Authors: I. Žofková ¹; P. Bubeníček ²; I. Sotorník ²
Authors place of work: Endokrinologický ústav Praha, ředitel doc. MUDr. Vojtěch Hainer, CSc. ¹; Nefrologická klinika IKEM Praha, přednosta prof. MUDr. Vladimír Teplan, DrSc. ²
Published in the journal: Vnitř Lék 2007; 53(6): 709-714
Category: Reviews

Summary

Hypogonadism is a frequent complication in patients with chronic renal insufficiency (CHRI). From a pathogenetic point of view, it is a disorder at the level of the hypothalamus caused by central inhibition of the pulsatile generation of gonadotropin releasing hormone (GnRH) and by a primary disorder of gonads. The cause of hypogonadism in dialysed patients is not completely known. The effect of inhibition of erythropoietin production is believed to be one of the factors, as well as the adverse effects of complicated therapeutic procedures and malnutrition. In men, the affection manifests itself as a disorder of sexual functions, inhibition of spermatogenesis, premature andropause and severe fatigue syndrome. Menstruation disorders, premature menopause and anovulation cycles are frequent symptoms in dialysed women. Androgen or estrogen substitution improves the quality of life in both sexes and slows down the loss of bone mass. Complete remission of hypogonadism is obtained, in the majority of patients, by renal transplant. The overview study deals with the pathogenesis, diagnosis and treatment of hypogonadism in dialysed patients.

Key words:
chronic renal insufficiency – hypogonadism – hormonal substitution

Zdroje

1. Barlier A, Jaquet P. Quinagolide - a valuable treatment option for hyperprolactinaemia. Eur J Endocrinology 2006; 154: 187-195.

2. Bonomini V, Orsoni G, Sorrentino MA et al. Hormonal changes in hemodialysis. Blood Purif 1990; 8: 54-68.

3. Burak W, Grzeszczak W, Trelewicz P et al. The effect of hemodialysis on levels of beta-endorphin in serum patients with chronic renal failure treated with erythropoietin. Przegl Lek 1996; 53: 54-57.

4. Carlson HE, Graber ML, Gelato MC et al. Endocrine effects of erythropoietin. Int J Artef Organs 1995; 18: 309-314.

5. Caticha O, Norato DY, Tambascia MA et al.Total body zinc depletion and its relationship to the development of hyperprolactinemia in chronic renal insufficiency. J Endocrinol Invest 1996; 19: 441-448.

6. Cepicky P, Sulkova S, Stroufova A et al. The correlation of serum prolactin level and psychic stress in women undergoing a chronic hemodialysis programme. Exp Clin Endocrinology 1992; 99: 71-72.

7. English K, Steed R, Diver M et al. Low dose transdermal testosterone therapy improves angina treshold in men with chronic stable angina. Circulation 2000; 102: 1906-1911.

8. Hochstetler LA, Flanigan MJ, Lim VS. Abnormal endocrine tests in a hemodialysis patient. J Am Soc Nephrol 1994; 4: 1754-1759.

9. Holley JL. The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis 2004; 11: 337-341.

10. Johansen KL. Treatment of hypogonadism in men with chronic kideny disease. Adv Chronic Kidney Dis 2004; 11: 348-356.

11. Kokot F, Wiecek A, Grzeszczak W et al. Influence of erythropoietin treatment on follitropin and lutropin response to luliberin and plasma testosterone levels in haemodialyzed patients. Nephron 1990; 56: 126-129.

12. Kook F, Wiecek A, Schmidt-Gay H et al. Influence of long-term erythropoietin therapy on endocrine abnormalities in haemodialyzed patients. Przegl Lek 1992; 49: 43-49.

13. Lawrence IG, Price DE, Hewlett TA et al. Erythropoietin and sexual dysfunction. Nephrol Dial Transplant 1997; 12: 741-747.

14. Lindberg JS, Moe SM. Osteoporosis in end-state renal disease. Semin Nephrol 1999; 19: 115-122.

15. Luboshitzki R, Wagner O, Lavi S et al. Abnormal melatonin secretion in hypogonadal men: The effect of testosterone treatment. Clin Endocrinol 1997; 47: 463-469.

16. Majdan M, Kotarski J, Ksiazek A et al. Relationship between some prognostic markers of HD patients and serum erythropoietin, insulin-like growth factor-1, leptin, parathormone and testosterone. Int Urol Nephrol 1999; 31: 563-569.

17. Matuszkiewicz-Rowinska J, Skorzewska K, Radowicki S et al. Menstrual disturbances and alterations in hypophyseal gonadal axis in end-stage premenopausal women undergoing hemodialysis: a multi-center study. Pol Arch Med Wewn 2003; 109: 609-615.

18. Matuszkiewicz-Rovinska J, Skorzewska K, Radowicki S et al. The benefits of hormone replacement therapy in pre-menopausal women with estrogen deficiency on haemodialysis. Nephrol Dial Transplant 1999; 14: 1238-1243.

19. Petrovic MS, Prelevic GM, Balint-Peric LA et al. The effect of hyperprolactinemia on biohumoral parameters of bone metabolism in women of reproductive age on chronic hemodialysis. Srp Arch Celok Lek 1992; 120: 15-18.

20. Poršová-Dutoit I. Léčba mužského hypogonadismu. In: Mužský hypogonadismus. Nedostatečná funkce mužských pohlavních žláz. Praha: Maxdorf 2005; 72-121.

21. Ramirez G, Bittle PA, Sanders H et al. The effects of corticotropin and growth hormone releasing hormones on their respective secretory axes in chronic hemodialysis patients before and after correction of anemia with chronic hemodialysis patients before and after correction of anemia with recombinant erythropoietin. J Clin Endocrinol Metab 1994; 78: 63-69.

22. Reid IR. Glucocorticoid-induced osteoporosis and other forms of secondary osteoporosis. In: Meunier PJ (ed). Osteoporosis: Diagnosis and Management. London: Dunitz 1998, 233-250.

23. Resic H, Alajbegovic A, Sahovic V et al. Effect of erythropoietin on gonadotropic hormones and sexual function in patients on hemodialysis. Med Arch 2004; 58: 113-115.

24. Saha MT, Saha HH, Niskanen LK et al. Time course of serum prolactin and sex hormones following succesfull renal transplantation. Nephron 2002; 92: 735-737.

25. Sasagawa I, Tateno T, Suzuki Y et al. Circulating levels of inhibin in hemodialysis males. Arch Androl 1998; 41: 167-171.

26. Schaefer F, Vogel M, Kerhoff G et al. Experimental uremia affects hypothalamic amino acid neurotransmitter milieu. J Am Soc Nephrol 2001; 12: 1218-1227.

27. Singh AB, Norris K, Modi N et al. Pharmacokinetics of a transdermal testosterone system in men with end stage renal disease receiving maintenance hemodialysis and healthy hypogonadal men. J Clin Endocrinol Metab 2001; 86: 2437-2445.

28. Soykan A, Boztas H, Kutlay S et al. Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey. Int J Impot Res 2005; 17: 359-363.

29. Tauchmanova L, Carrano R, Sabbatini M et al. Hypothalamic-pituitary-gonadal axis function after successful kidney transplantation in men and women. Human Reprod 2004; 19: 867-873.

30. Tokgoz B, Utas C, Dogukan A et al. Effects of long-term erythropoietin therapy on the hypothalamo-pituitary-testicular axis in male CAPD patients. Perit Dial Int 2001; 21: 448-454.

31. Tsujimura A, Matsumiya K, Tsuboniva N et al. Effect of renal transplantation on sexual function. Arch Androl 2002; 48: 467-474.

32. Valdes Socin A, Magis D, Betea D et al. Pituitary diseases in elderly patients with chronic renal insufficiency. Rev Med Liege 2002; 57: 375-381.

33. Watschinger B, Watzinger U, Templ H et al. Effect of recombinant human erythropoietin on anterior pituitary function in patients on chronic hemodialysis. Horm Res 1991; 36: 22-26.

34. Žofková I, Sotorník I. The effect of parathyroidectomy on thyrotropic and lactotropic functions in patients with renal osteodystrophy. Nephron 1995; 71: 284-290.