HYPOTHALAMOPITUITARY ADRENAL AXIS IN UREMIA - EVIDENCE FOR PRIMARY ADRENAL DYSFUNCTION

To study hypothalamo-pituitary-adrenal axis disturbances in chronic re nal failure, we administered corticotrophin-releasing hormone to patie nts undergoing haemodialysis and CAPD and to normal controls. Cortisol , ACTH, and ACTH precursors were measured before and after corticotrop hin-releasing hormone using sensitive and specific two-site assays. Ba seline ACTH and cortisol were similar in all groups. Peak values occur red at 30 min (ACTH) and between 30 and 60 min (cortisol). The cortiso l (but not the ACTH) responses were significantly reduced in patients with renal failure (P < 0.05). ACTH precursors did not change from bas eline following corticotrophin-releasing hormone but were significantl y elevated in patients with renal failure compared to controls (P < 0. 01). The reduced cortisol response to corticotrophin-releasing hormone may reflect a primary defect of adrenal function in renal failure.