Abstract
Linear growth failure is frequent after renal transplantation (Tx). The hypothalamic-pitiutary-somatotrophic and thyrotropic axis was evaluated in 16 prepubertal children (9 boys) aged 8.8-17.3 years (x̄= 12.0), 1.1 to 6.5 years (x̄= 3.5) post-Tx. Immunosuppressive treatment included azathioprine, ciclosporine A and methylprednisone 0.2mg/kg/day. Serum creatinine was 0.7-2.0 mg/dl (x̄= 1.3); it was ⋜ 1.0mg/dl in 7. Height standard deviation score (SDS) was -2.8 ± 0.3 (x̄ + SE), growth velocity was 2.0 ± 0.3 cm/year. Mean nocturnal growth hormone (x̄GH) was 3.8 ± 0.8ng/ml; in 3 patients it was ⋜ 1ng/ml. GH response to arginine and clonidine was 8ng/ml in 5 of 16 and in 7 of 12 patients, respectively; 2 patients had deficient responses in both tests. IGF-1 levels (x̄= 1.5 ± 0.1 U/ml) were above the mean normal value in all patients. Correlation between x̄GH and height was r: 0.5, p <0.02. Mean total T3 (1.7 ± 0.2ng/dl) and total T4 (9.9 ± 0.5ug/dl) were normal. Free T4 levels (x̄= 1.1 ± 0.1ng/dl) were low in 3 of 8 patients. In 13 patients mean basal TSH value was normal (3.7 ± 0.3uU/ml) with deficient TSH response to TRH -IN 7 and delayed TSH response in 3. Height was low after Tx, even when renal function was normal. The alterations in GH and thyroid hormone secretion suggest hypothalamic-pituitary dysfunction. High or normal IGF-1 levels suggest IGF-1 resistance.
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Ferraris, J., Fainstein-Day, P., Gutman, R. et al. HYPOTHALAMIC-PITUITARY DYSFUNCTION IN PREPUBERTAL PATIENTS AFTER RENAL TRANSPLANTATION. Pediatr Res 32, 737 (1992). https://doi.org/10.1203/00006450-199212000-00024
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DOI: https://doi.org/10.1203/00006450-199212000-00024