Effects of alternate-day or daily prednisone treatment on GH and cortisol levels in growth-retarded children after renal transplantation.
Growth retardation after renal transplantation (RTx) is generally attributed to prednisone (PDN) administration, although the exact mechanism is poorly understood. In a group of 19 growth-retarded patients after RTx, we studied the effect of alternate-day (group AD, n = 12) and daily (group D, n = 7) PDN treatment on the spontaneous plasma growth hormone (GH) and cortisol profiles, for 48 h in group AD and for 24 h in group D. The maximal plasma GH response to arginine provocation (ATT) and plasma levels of insulin-like growth factor-1 (IGF-1), IGF-2 and serum IGF-binding proteins (IGFBP) were also determined. For both groups the PDN doses were recalculated as daily doses for comparison. The median 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 m2 in all patients. We hypothesized that alternate-day PDN therapy and even more so daily PDN therapy would have a deleterious effect on GH and cortisol secretion and would result in lower GH-dependent growth factors as compared to control data of healthy children. Our findings revealed that growth-retarded renal allograft patients, receiving 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 and -2 levels. Mean serum IGFBP-1 levels were normal, but mean serum IGFBP-3 levels were significantly increased, while a significant negative correlation was found between the GFR and serum IGFBP-3 levels.(ABSTRACT TRUNCATED AT 250 WORDS)
Hokken-Koelega
A C
AC
Department of Pediatrics, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
de Muinck Keizer-Schrama
S M
SM
Drop
S L
SL
D000293:Adolescent; D001120:Arginine; D002352:Carrier Proteins / Q000378:metabolism; D002648:Child; D003864:Depression, Chemical; D004334:Drug Administration Schedule; D005260:Female; D006130:Growth Disorders / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D002352:Carrier Proteins; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D013006:Growth Hormone; D001120:Arginine; D011241:Prednisone; D006854:Hydrocortisone