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Pituitary-Adrenocortical Function in Chronic Renal Failure: Studies of Episodic Secretion of Cortisol and Dexamethasone Suppressibility^*

Medical Service, Veterans Administration Medical Center Brooklyn 11209 Department of Medicine, Downstate Medical Center Brooklyn, New York 11203

Address all correspondence and requests for reprints to: Dr. Eleanor Z. Wallace, Chief, Medical Service, Chief, Endocrinology Section, Brooklyn Veterans Administration Medical Center, 800 Poly Place, Brooklyn, New York 11209.

Pituitary-adrenocortical function was studied in patients with chronic renal failure (CRF) and compared with that in normal subjects. All CRF patients were on chronic hemodialysis. The mean morning plasma total and free (nonprotein bound) cortisol levels were higher in patients with CRF. Episodic secretion of cortisol was studied in plasma sampled every 20 min for 24 h. CRF patients demonstrated normal circadian rhythmicity, as evidenced by times of peak secretory activity and number of peaks per 24 h. Mean 24-h plasma total cortisol levels were twice the normal levels in CRF patients. Nine of 10 patients with CRF did not suppress plasma total cortisol levels with 1 mg dexamethasone. Four of 10 patients with CRF suppressed with 2 mg dexamethasone orally for 2 days, 5 patients suppressed after 8 mg dexamethasone administration, and 1 patient with CRF resisted suppression. Hemodialysis did not alter mean 24-h cortisol levels or numbers of secretory episodes but produced a shift of secretory activity into the dialysis time period. These studies show alterations in cortisol dynamics in which increased plasma cortisol levels and dexamethasone resistance coexist with normal circadian rhythmicity.

^* Presented in part at the 61st Annual Meeting of The Endocrine Society, Anaheim, CA, June 14, 1979. This work was supported by RAG funds from the V.A.

Received May 11, 1979.

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