Serum Prolactin (PRL), Testosterone (T), Dehydroepiandrosterone (D) and Dehydroepiandrosterone Sulphate (D-s) in Male Uraemic Patients on Maintenance Haemodialysis: Effect of Bromocriptine

Abstract

Hormonal alterations are consequences, as well as causes of some pathological abnormalities developing in patients with chronic renal failure (CRF). The most important differences occur in the hormones regulating calcium metabolism: serum levels of parathormone and calcitonin increase, while those of active vitamin D metabolites are absent or undetectable. Other parts of the endocrine system are also involved. Hyperprolactinaemia (Gomez, Cueva, Wauters and Lemarchand-Beraud 1980), hypergonadotrophic hypogonadism (Sy Lym and Fang 1975), hypersomatotropinaemia, sometimes hypercorticotropinaemia, various alterations in the hormones of the thyroid, hyperinsulinism, hypergastrinism (Bonomini, Orsoni, Stefoni and Vangelista 1979) have been described. Serum levels of adrenocortical hormones: Cortisol and aldosterone (Bonomini et al. 1979) as well as D and D-s (Sziics and Bodrogi 1980) seem to be normal.Male impotence is a disabling and poorly tolerated complication in CRF patients on maintenance haemodialysis (MHD). In this condition a causative role was suggested among others of increased serum PRL and/or decreased serum T levels. On the other hand, some data point to the trophic role of PRL on the adrenal androgen (D or its sulphate, D-s) production (Seki and Kato 1981).To study the relationship between the above mentioned hormones and clinical signs serum PRL, T, D and D-s levels were detected in male CRF patients on MHD, before and after treatment with bromocriptine (Br, Parlodel, Sandoz, kindly supplied by Sandoz AG, Basel). Material and MethodsSeven male patients were studied (aged 26-50, mean 37,8) with CRF on MHD 3 times weekly. Unheparinized blood was withdrawn just before dialysis and the sera were stored at -25°C until determinations. Radioimmunological methods were employed for determinations of PRL (Prolactin-Ter, Serono), T (Bodrogi and Feher 1980), D {Abraham, Buster, Kyle, Corrales and Teller 1973) and D-s (Bodrogi and Feher 1982. Patients did not have hormonal treatment but in 4 cases hypertension was treated with alfa-methyldopa (Dopegyt, E.Gy.T., 750 mg), a drug which enhances serum PRL level in some CRF patients (Gomez et al. 1980). Parlodel 2.5 mg twice daily was given for at least 3 weeks and thereafter hormonal determinations were repeated. Inquiries about sexual complaints were made before treatment, at the time of hormonal determinations and 2 months later, still on Br. Results and DiscussionBefore treatment serum PRL levels were elevated, while T was subnormal in 2 patients and normal in the other ones. Serum D and D-s levels were normal, though often in the low normal range (Table 1). Various sexual complaints (potency, libido, erection, pollution) occurred in each person. As a result of Br therapy, PRL decreased significantly (T: 3.41 P < 0.05), became normal in 3, remaining only slightly elevated in the others. Serum T, D and D-s (except T elevation in one patient) remained practically unchanged. Sexual complaints improved in 5 patients. There was a weak correlation between improvement in ...