Acs. Hokkenkoelega et al., EFFECTS OF ALTERNATE-DAY OR DAILY PREDNISONE TREATMENT ON GH AND CORTISOL-LEVELS IN GROWTH-RETARDED CHILDREN AFTER RENAL-TRANSPLANTATION, Journal of pediatric endocrinology, 7(2), 1994, pp. 119-125
Growth retardation after renal transplantation (RTx) is generally attr
ibuted to prednisone (PDN) administration, although the exact mechanis
m is poorly understood. In a group of 19 growth-retarded patients afte
r RTx, we studied the effect of alternate-day (group AD, n=12) and dai
ly (group D, n=7) PDN treatment on the spontaneous plasma growth hormo
ne (GH) and cortisol profiles, for 48 h in group AD and for 24 h in gr
oup D. The maximal plasma GH response to arginine provocation (ATT) an
d plasma levels of insulin-like growth factor-1 (IGF-1), IGF-2 and ser
um IGF-binding proteins (IGFBP) were also determined. For both groups
the PDN doses were recalculated as daily doses for comparison. The med
ian PDN dose in both groups was similar, 0.15 mg/kg/day, with a range
of 0.10-0.25 mg/kg/day. Glomerular filtration rate (GFR) was above 20
ml/min/1.73 m(2) in all patients. We hypothesized that alternate-day P
DN therapy and even more so daily PDN therapy would have a deleterious
effect on GH and cortisol secretion and would result in lower GH-depe
ndent growth factors as compared to control data of healthy children.
Our findings revealed that growth-retarded renal allograft patients, r
eceiving either alternate-day or daily PDN therapy, have significantly
lower mean plasma GH levels than controls, but normal diurnal rhythm
of GH and cortisol secretion as well as normal immunoreactive IGF-1 an
d -2 levels. Mean serum IGFBP-1 levels were normal, but mean serum IGF
BP-3 levels were significantly increased, while a significant negative
correlation was found between the GFR and serum IGFBP-3 levels. In co
nclusion, growth retardation after RTx may not be solely the result of
decreased GH secretion. Suboptimal renal graft function together with
increased levels of IGFBP-3 and decreased IGF bioavailability may, in
combination with the presumed direct effects of PDN on the growth pla
te, contribute towards growth retardation following RTx.