Effects of alternate-day or daily prednisone treatment on GH and cortisol levels in growth-retarded children after renal transplantation.

Abstract

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)