Handelsman D J, Dong Q
Department of Obstetrics and Gynaecology, University of Sydney, Australia.
Endocrinol Metab Clin North Am. 1993 Mar;22(1):145-61.
Chronic renal failure causes extensive neuroendocrine disturbance, including marked hypothalamo-pituitary dysfunction which is reversed by renal transplantation but not dialysis. Gonadal dysfunction in uremia is manifest as delayed puberty in adolescents; as testicular atrophy, hypospermatogenesis, infertility, impotence in men; and as anovulation, infertility, and menstrual disturbance in women. Gonadal steroidogenesis and gametogenesis are impaired and gonadotropin levels are increased. In addition to evidence of defects in pituitary and gonadal function, increasing evidence indicates the importance of alterations in hypothalamic regulation of pituitary-gonadal function in the pathogenesis of uremic hypogonadism. Experimental uremia induced by subtotal nephrectomy in mature rats causes gonadal dysfunction, which is principally due to aberrant neuroendocrine regulation of GnRH secretion involving inhibition of GnRH secretion, hypersensitivity to negative testicular feedback, and resistance to naloxone, a triad of features termed ontogenic regression.
慢性肾衰竭会导致广泛的神经内分泌紊乱，包括明显的下丘脑 - 垂体功能障碍，这种功能障碍可通过肾移植逆转，但透析无法做到。尿毒症中的性腺功能障碍在青少年中表现为青春期延迟；在男性中表现为睾丸萎缩、精子发生减少、不育、阳痿；在女性中表现为无排卵、不育和月经紊乱。性腺类固醇生成和配子发生受损，促性腺激素水平升高。除了垂体和性腺功能缺陷的证据外，越来越多的证据表明，下丘脑对垂体 - 性腺功能调节的改变在尿毒症性性腺功能减退的发病机制中具有重要意义。在成熟大鼠中通过次全肾切除诱导的实验性尿毒症会导致性腺功能障碍，这主要是由于GnRH分泌的异常神经内分泌调节，包括GnRH分泌抑制、对睾丸负反馈的超敏反应以及对纳洛酮的抵抗，这一组特征被称为个体发育退化。
