Growth hormone metabolism in chronic kidney disease
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
Progression to end-stage renal disease is associated with a variety of abnormalities in growth hormone regulation, including changes in its plasma concentration, in the regulation of its release, and in end-organ responsiveness. As an example, the plasma growth hormone concentration is commonly elevated in chronic kidney disease due to the interplay of several factors [1,2].
Decreased renal clearance appears to play a major role in the genesis of this problem since filtered growth hormone is normally reabsorbed in and metabolized by the proximal tubule .
Enhanced growth hormone secretion also may contribute to the rise in plasma levels, although it is likely to be of lesser importance. Children with end-stage renal disease have an increase in the number of secretory bursts of growth hormone when compared with children with normal renal function . Why this occurs is not clear, but protein-calorie malnutrition and stress may play a role.
Plasma growth hormone levels fall to low-normal values after the institution of maintenance dialysis, an effect that may be mediated in part by acetate (which has now been largely replaced by bicarbonate) in the dialysis bath . For reasons that are not well understood, the administration of recombinant human erythropoietin also leads to a reduction in the basal concentration of growth hormone .
REGULATION OF GROWTH HORMONE RELEASE
A number of observations suggest that the hypothalamic-pituitary regulation of growth hormone is perturbed in chronic kidney disease . As an example, normal individuals suppress growth hormone release in response to induced hyperglycemia; in contrast, glucose induces a paradoxical rise in growth hormone levels in advanced renal failure . In addition, insulin-induced hypoglycemia, which is a potent stimulus to growth hormone release in normal subjects, elicits a blunted response in chronic kidney disease patients .
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