ACCUMULATION OF 5-ALPHA-REDUCED ANDROGEN GLUCOSIDURONATES ASSOCIATED WITH IMPAIRED REMOVAL IN YOUNG MALE HEMODIALYSIS-PATIENTS

Hypothalamic-pituitary gonadal function is commonly altered in dialysi s patients. Even though an improvement in general status and well-bein g has been noted after recombinant human erythropoietin supplementatio n, no significant changes were observed in the sex hormone profile. Pi tuitary gonadal axis as well as 5 alpha-reduced androgen glucosidurona tes (i.e. 5 alpha-androstane,3 alpha,l7 beta-diol and androsterone) pr ofiles were studied in 23 young male stable dialyzed patients and comp ared to an age-matched group of healthy subjects. 5 alpha-Reduced andr ogen glucosiduronates are products of peripheral testosterone (T) meta bolism and seem to be a useful tool in assessment of the male androgen status. Their polarity facilitates their urinary excretion, and their clearance is similar to the glomerular filtration rate in healthy men . We observed 1) a pituitary-leydig cell dysfunction supported by norm al serum estradiol and T levels, low free T, and increased LH levels; 2) an alteration of the dehydroepiandrosterone (DHEA) sulfate-DHEA int erconversion, reflected by a dramatic decrease in DHEA while DHEA sulf ate levels remained in the normal range; 3) an accumulation of 5 alpha -reduced androgen glucosiduronates, whose removal was impaired as show n by their very low sieving coefficients (<0.012). Taken together, the above observations are consistent with alteration of spermatogenesis with respect to dialysis duration in which earlier elevated baseline s erum LH levels indicate a primary defect in Leydig cell function.