Oertel P J, Lichtwald K, Häfner S, Rauh W, Schönberg D, Schärer K
Kidney Int Suppl. 1983 Nov;15:S34-9.
Delayed puberty in children with chronic renal failure (CRF) may be due to gonadal dysfunction, increased plasma binding of gonadal hormones, or changes of the hypothalamo-pituitary axis. Plasma androgens were studied in 17 prepubertal boys with preterminal CRF. In addition, the response of luteinizing and follicle-stimulating hormones (LH, FSH) to luteinizing-releasing hormone (LHRH) was followed in the plasma of these boys and of 12 prepubertal girls with CRF. Plasma testosterone (T) was significantly lower in the CRF boys than it was in the controls (mean, 9 vs. 22 ng/ml) and concerned also the free T fraction (2.5% in both groups). Dihydro-T was similarly reduced in CRF, resulting in a normal T/DHT ratio. Basal plasma LH levels were significantly elevated in boys (1.0 vs. 0.5 ng/ml) and in girls with CRF (1.4 vs. 0.4 ng/ml), whereas mean basal FSH values were similar to controls. After LHRH administration, peak levels of LH and FSH were not different in CRF and control children; however, the absolute differences from basal to peak values were lower in CRF. These findings may indicate that Leydig cell dysfunction in CRF already occurs before the onset of puberty. The blunted LH and FSH responses to LHRH suggest an additional disturbance at the hypothalamo-pituitary level.
慢性肾衰竭（CRF）患儿青春期发育延迟可能是由于性腺功能障碍、性腺激素血浆结合增加或下丘脑 - 垂体轴改变所致。对17例终末期前CRF的青春期前男孩的血浆雄激素进行了研究。此外，还对这些男孩以及12例青春期前CRF女孩血浆中黄体生成素和卵泡刺激素（LH、FSH）对促黄体生成素释放激素（LHRH）的反应进行了跟踪。CRF男孩的血浆睾酮（T）显著低于对照组（均值分别为9 ng/ml和22 ng/ml），游离T分数也是如此（两组均为2.5%）。CRF患者的双氢睾酮同样降低，导致T/双氢睾酮比值正常。CRF男孩（1.0 ng/ml对0.5 ng/ml）和女孩（1.4 ng/ml对0.4 ng/ml）的基础血浆LH水平显著升高，而平均基础FSH值与对照组相似。给予LHRH后，CRF患儿和对照儿童的LH和FSH峰值水平无差异；然而，CRF患儿从基础值到峰值的绝对差异较小。这些发现可能表明CRF患者的睾丸间质细胞功能障碍在青春期开始前就已发生。LH和FSH对LHRH反应减弱表明下丘脑 - 垂体水平存在额外的紊乱。
