Parathyroid function and pituitary-gonadal axis in male uremics; effects of dietary treatment and of maintenance hemodialysis.

Parathyroid and pituitary-gonadal secretions were studied in 18 male uremics following a low protein diet supplemented with essential amino acids and ketoanalogues (SD), and in 8 subjects on maintenance hemodialysis (MHD). SD corrected high serum PTH and low serum testosterone (sT) levels, while pituitary hormones (LH, FSH, PRL) were elevated and did not change. Patients on MHD had very high siPTH, PRL and LH levels, while sT was markedly low. These data suggest that PTH is a prominent cause of sexual dysfunction in male uremics, since SD can restore sT secretion by correcting PTH levels, without improving pituitary dysfunctions. In dialyzed patients secondary hyperparathyroidism worsens and is an important cause of low sT secretion, but also a severe hyperprolactinemia develops, which may further impair gonadal function.