Adolescent Medicine Service, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico.
Unit of Nutrition, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Pediatr Nephrol. 2020 Jun;35(6):1041-1049. doi: 10.1007/s00467-020-04494-7. Epub 2020 Feb 10.
In adolescents with chronic kidney disease (CKD), menstrual disorders (MD) are common, which can make the management of CKD difficult and can sometimes delay renal transplantation. This study aimed to identify the usefulness of hormonal measurements in adolescents with CKD and their relationships with MD during a 1-year follow-up.
A prospective cohort study was designed. Adolescents with CKD stages IV and V were included. Through clinical files and via interview, the ages at puberty onset, menarche and the date of last menstruation were identified. A 1-year follow-up was conducted over a menstrual cycle calendar. At the beginning of follow-up, routine hormonal profiles (thyroid profiles, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol) were assessed. We compared the hormonal profiles of the patients with and without MD (wMD vs. woMD). Comparisons between groups were made by Wilcoxon and Fisher's tests. Logistic regression analysis was used.
Fifty-seven patients, including 30 patients classified as wMD, were analyzed. The median age was 15 years, and the median time of CKD evolution was 18 months. There were no differences in general and biochemical characteristics between patients wMD and woMD. In terms of hormonal measurements, the levels of thyroid-stimulating hormone (TSH) and prolactin were higher in the wMD patients. A prolactin level ≥ 36.8 ng/ml was a risk factor for presenting with MD (RR 34.4, p = 0.002).
Hyperprolactinemia is correlated with MD in adolescents with CKD.
在患有慢性肾脏病（CKD）的青少年中，月经失调（MD）很常见，这会使 CKD 的治疗变得困难，有时甚至会延迟肾移植。本研究旨在确定激素测量在患有 CKD 的青少年中的作用，以及它们在 1 年随访期间与 MD 的关系。
设计了一项前瞻性队列研究。纳入 CKD 四期和五期的青少年。通过临床病历和访谈，确定青春期开始、初潮和末次月经的日期。通过月经周期日历进行为期 1 年的随访。在随访开始时，评估常规激素谱（甲状腺谱、催乳素、黄体生成素（LH）、卵泡刺激素（FSH）和雌二醇）。我们比较了有 MD（wMD）和无 MD（woMD）的患者的激素谱。通过 Wilcoxon 和 Fisher 检验比较组间差异。使用逻辑回归分析。
共分析了 57 例患者，其中 30 例患者被归类为 wMD。中位年龄为 15 岁，CKD 病程的中位数为 18 个月。wMD 和 woMD 患者的一般和生化特征无差异。在激素测量方面，wMD 患者的促甲状腺激素（TSH）和催乳素水平较高。催乳素水平≥36.8ng/ml 是出现 MD 的危险因素（RR 34.4，p=0.002）。
在患有 CKD 的青少年中，高催乳素血症与 MD 相关。
