We have investigated the effect of human GH on erythropoietin (EPO) secretion in eight anemic patients with chronic renal failure (CRF) (three males and ®ve females, aged from 46 to 83 years). Recombinant human GH was infused subcutaneously at a¯ow rate of 2 mg/kg body weight per 0.1 ml/h for 72 h using a portable infusion pump. Blood samples were obtained immediately before and 2, 4,6,12,24,36, 48, 60, 72, 84, 96, 108, 120 and 168 h after the start of GH infusion. Storage urine samples were obtained before and 24, 48 and 72 h after the start of the infusion. The mean (6 S.E.M.) basal plasma GH levels increased from 1.9 6 0.3 to 18.8 6 0.7 mg/l during the GH infusion. Plasma IGF-I levels increased 12 h after the start of GH treatment and the mean peak values of 403.6 6 38.5 mg/l were obtained at 72 h. Plasma EPO levels increased 6 h after the start of GH infusion, and the peak values of 38.4 6 11.6 IU/l were obtained at 96 h (P < 0.05 vs basal values 24.5 6 7.2 IU/l). Reticulocyte counts increased from 28.7 6 5.2´10 3 /ml to 40.3 6 8.0´10 3 /ml at 108 h, 43.6 6 9.2´10 3 /ml at 120 h and 41.7 6 7.7´10 3 /ml at 160 h (P < 0.05). Serum urea nitrogen decreased at 72 h (P < 0.05), whereas there was no signi®cant change in urinary excretion of nitrogen. Hemoglobin levels were not signi®cantly changed throughout the experimental period. These ®ndings indicate that human GH has a stimulating effect on EPO secretion in anemic patients with CRF.
Abstract. A 68-year-old woman was admitted to our hospital for severe normochromic and normocytic anemia. She had a history of prolonged postpartum hemorrhage at the age of 20 yr. Her menses were resumed thereafter and she gave birth to two other children, but her lactation was poor. She had no subjective symptom until the age of 63 yr when she complained of weakness and cold intolerance. Laboratory examination at admission revealed severe anemia (Hb 7.2 g/dl) with relatively low serum erythropoietin (EPO 20.4 mIU/ml) and panhypopituitarism.Empty sella was also found by magnetic resonance imaging (MRI). Hb levels were corrected by replacement with levothyroxine (75 µg/day) and hydrocortisone (10 mg/day), which was accompanied by an increase in serum EPO levels. These findings indicate that this is a very rare case of Sheehan's syndrome with severe anemia and empty sella proved at the longest reported interval of 48 yr after the provoking delivery, and that serum EPO levels are increased by replacement with glucocorticoid and thyroxin in panhypopituitarism.
A 43-year-old female was admitted to our hospital for polydipsia and hyperglycemia. She had total blindness and globes were not recognized by inspection, indicating clinical anophthalmia. Physical examination revealed short stature, obesity, prematurely gray hair, shortness of fingers and toes, syndactyly, and multiple dental caries. Laboratory examination showed hyperglycemia, increased glycosilated hemoglobin (HbA1c) and insulin resistance on euglycemic glucose clamp. Blunted growth hormone (GH) secretion was shown in response to insulin-induced hypoglycemia, arginine infusion, and GH-releasing hormone (GHRH) loading test, and in 24 h spontaneous GH profile. Magnetic resonance imaging (MRI) and computed tomography (CT) showed dysostosis of orbit, defect of optic nerve, enlarged suprasellar cistern, and prolonged pituitary stalk. This may be the first report of a unique case with GH deficiency accompanied by clinical anophthalmia, hypoplastic orbits, digital dysplasia, short stature, obesity, and diabetes mellitus.
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