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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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