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Acta Neurochirurgica

, Volume 123, Issue 1–2, pp 64–75 | Cite as

The function of the hypothalamo-pituitary axis in brain dead patients

  • K. Arita
  • T. Uozumi
  • S. Oki
  • K. Kurisu
  • M. Ohtani
  • T. Mikami
Research Articles

Summary

In order to find out the function of the hypothalamo-pituitary axis in brain dead patients, pituitary and hypothalamic hormone concentrations were measured and several anterior pituitary releasing tests were carried out in 39 brain dead patients. In addition, cerebral blood flow measurements were simultaneously performed. In almost all cases, the blood concentration of pituitary and hypothalamic hormones were above the sensitivity of the assay. Anterior pituitary releasing tests indicated that efficient functions of the hypothalamus were severely suppressed, while the normal secretory mechanism of the anterior pituitary was partially preserved in brain dead patients. Histological changes of hypothalamic neurons varied from barely detectable ghost cells to nearly normal cells even in the same case. Although, the remaining circulation seemed not to be sufficient enough to maintain integrated hypothalamo-pituitary function, as shown by the examinations of cerebral blood flow, the presence of hypothalamic hormones in the systemic circulation suggests that these hormones were released and carried from the hypothalamus by minimal flow which is preserved even after the diagnosis of brain death.

Keywords

Brain death hypothalamic hormone pituitary hormone cerebral blood flow 

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References

  1. 1.
    Abdel-Dayem HM, Bahaar RH, Sigaurdsson GH, Sadeck S, Olivecrona H, Ali AM (1989) The hollow skull: a sign of brain death in Tc-99 m HM-PAO brain scintigraphy. Clin Nucl Med 14: 912–916PubMedGoogle Scholar
  2. 2.
    Adams RD, Jequier M (1969) The brain death syndrome; hypoxemic panencephalopathy. Schweiz Med Wschr 99: 65–73PubMedGoogle Scholar
  3. 3.
    Abrams PL, Parker ML, Blanco S, Reichlin S, Daughaday WH (1966) Hypothalamic regulation of growth hormone secretion. Endocrinology 78: 605–613PubMedGoogle Scholar
  4. 4.
    Antony GJ, Van Wyk JJ, French FS, Weaver RP, Dugger GS, Timons RL, Newsome JF (1969) Indluence of pituitary stalk section on growth hormone, insulin and TSH secretion in women with metastatic breast cancer. J Clin Endocrinol Metab 29: 1238–1250PubMedGoogle Scholar
  5. 5.
    Arita K, Uozumi T, Oki S, Ohtani M, Taguchi H, Morio M (1988) Hypothalamic pituitary function in brain death patients. From blood pituitary hormones and hypothalamic hormones. Neurol Surg (Tokyo) 16: 1163–1171Google Scholar
  6. 6.
    Aruga T, Ono K, Kawahara N, Sasaki M, Tsutsumi H, Toyooka H, Mii K, Tsuzuki M, Takakura K (1983) Some practical problems of clinical diagnosis of brain death. Brain and Nerve (Tokyo) 35: 777–785Google Scholar
  7. 7.
    Ashwal S, Schneider S (1987) Brain death in children: Part II. Pediatr Neurol 3: 69–77PubMedGoogle Scholar
  8. 8.
    Bakke JL, Lawrence NL (1980) Disappearance rate and distribution of anterior pituitary function in patients with posttraumatic diabetes insipidus. J Clin Endocrinol Metab 51: 1279–1282PubMedGoogle Scholar
  9. 9.
    Beecher HK (1968) A definition of irreversible coma. JAMA 205: 337–340PubMedGoogle Scholar
  10. 10.
    Besser GM, Orth DB, Nicholson WE, Beyny RL, Abe K, Woodham JP (1971) Dissociation of the disappearance of bioactive and radioimmunoactive ACTH from plasma in man. J Clin Endocrinol Metab 32: 595–603PubMedGoogle Scholar
  11. 11.
    Bishop W, Krulich L, McCann SM (1971) The effect median eminence (ME) lesions on plasma levels of FSH, LH and prolactin in the rat. Proc Soc Expl Biol Med 136: 925–927Google Scholar
  12. 12.
    Black P (1978) Brain death. N Engl J Med 299: 388Google Scholar
  13. 13.
    Bregqouits E, Bergstrom K (1972) Angiography in cerebral death. Acta Radiol Diag 12: 283–288Google Scholar
  14. 14.
    Chikamori K, Suehiro F, Ogawa T, Sato K, Mori H, Oshima I, Saito S (1981) Distribution volume, metabolic clearance and plasma half disappearance time of exogenous luteinizing hormone releasing hormone in normal women and women with obesity and anorexia nervosa. Acta Endocrinol 96: 1–6PubMedGoogle Scholar
  15. 15.
    Chihara K, Kashio Y, Kita T, Okimura Y, Kajo H, Abe H, Fujita T (1986) L-Dopa stimulates release of hypothalamic growth hormone-releasing hormone in humans. J Clin Endocrinol Metab 62: 466–473PubMedGoogle Scholar
  16. 16.
    Chrisofides ND, Stephanou A, Suzuki H, Yiangou Y, Bloom SR (1984) Distribution of immunoreactive growth hormone-releasing hormone in the human brain and intestine and its production by tumors. J Clin Endocrinol Metab 59: 747–751PubMedGoogle Scholar
  17. 17.
    Clarke IJ, Cummins JT, de Krester DM (1983) Pituitary gland function after disconnection from direct hypothalamic influences in the sheep. Neuroendocrinology 36: 376–384PubMedGoogle Scholar
  18. 18.
    Daughaday WH (1985) The anterior pituitary. In: Wilson J, Foster DW (eds) Textbook of endocrinology. Saunders, Philadelphia, pp 568Google Scholar
  19. 19.
    Elkind-Hirsch K, Ravnikar V, Turchinsky D, Schiff I, Ryan KJ (1984) Episodic secretory patterns of immunoreactive luteinizing hormone releasing hormone. (IR-LH-RH) in the systemic circulation of normal women throughout the menstrual cycle. Fertil Steril 41: 56–61PubMedGoogle Scholar
  20. 20.
    Froman LA, Bernardis LL (1968) Growth hormone and insulin levels in wealing rats with ventromedial hypothalamic lesions. Endocrinology 82: 1125–1132PubMedGoogle Scholar
  21. 21.
    Guyton AC (1976) Circulatory physiology. Saunders, Philadelphia, pp 1000–1004Google Scholar
  22. 22.
    Hall GM, Mashiter K, Lumley J, Robson JG (1980) Hypothalamic-pituitary function in the “brain-dead” patient. Lancet 2: 1259Google Scholar
  23. 23.
    Hassler W, Steinmetz H, Gawlowski J (1988) Transcranial Doppler ultrasonography in raised intracranial pressure and intracranial circulatory arrest. J Neurosurg 68: 745–751PubMedGoogle Scholar
  24. 24.
    Hassler W, Steinmetz H, Pirschel J (1989) Transcranial Doppler study of circulatory arrest. J Neurosurg 71: 195–201PubMedGoogle Scholar
  25. 25.
    Herrick CJ (1918) An introduction to neurology, 2nd Ed. Saunders, Philadelphia, pp 114–135Google Scholar
  26. 26.
    Hinokuma K, Ikuta F (1992) Survival of neurons in the hypothalamus and spinal cord in ischemia, anoxia and hypoglycemia. Adv Neurolog Sci (Tokyo) 36: 261–270Google Scholar
  27. 27.
    Howlett TA, Keogh AM, Perry L, Touzel R, Rees L (1989) Anterior and posterior pituitary function in brain-stem-dead donors. Transplantation 47: 828–834PubMedGoogle Scholar
  28. 28.
    Ikuta F, Takeda S (1992) Neuropathology required from “brain death”. Adv Neurolog Sci (Tokyo) 36: 322–344Google Scholar
  29. 29.
    Imberti R, Filisetti P, Preseglio I, Mapelli A, Spriano P (1990) Confirmation of brain death utilizing thyrotropine-releasing hormone stimulation test. Neurosurgery 27: 167PubMedGoogle Scholar
  30. 30.
    Ingvar DA, Wilden L (1972) Hjärndöt Sammenfattning av ett symposium. Läkartidningen 69: 3804–3814Google Scholar
  31. 31.
    Jefferson NR, Ameratunga B, Rajapaksh S (1975) Angiographic evidence of brain death. Aus Radiol 19: 289–296Google Scholar
  32. 32.
    Keogh AM, Howlett TA, Perry L, Rees LH (1988) Pituitary function in brain-stem dead organ donors. A prospective survey. Transplant Proc 20: 729–730PubMedGoogle Scholar
  33. 33.
    Korein J, Braunstein P, George A, Witcher M, Kricheff I, Lieberman A, Pearson J (1977) Brain death. I. Angiographic correlation with radioisotopic bolus technique for evaluation of critical deficit of cerebral blood flow. Ann Neurol 2: 195–205PubMedGoogle Scholar
  34. 34.
    Laurin NR, Driedger AA, Hurwitz GA, Matter AG, Powe JE, Chamberlain MJ, Zabel PL, Pavlosky WF (1989) Cerebral perfusion imaging with technetium-99m HM-PAO in brain death and severe central nervous system injury. J Nucl Med 30: 1627–1635PubMedGoogle Scholar
  35. 35.
    Lauson HD (1974) Metabolism of the neurohypophysial hormones. In: Sawyer E (ed) Handbook of physiology, Section 7, Vol 4, Part 1. American Physiological Society, Washington, DC, pp 287–393Google Scholar
  36. 36.
    Low LCK (1991) Growth hormone-releasing hormone: clinical studies and therapeutic aspects. Neuroendocrinology 53 [Suppl 1]: 37–40PubMedGoogle Scholar
  37. 37.
    Martin JB (1973) Neural regulation of growth hormone secretion. N Engl J Med 288: 1384–1392PubMedGoogle Scholar
  38. 38.
    Meyer A (1898) Critical review of the date and general methods and deductions of modern neurology. J Comp Neurol 8: 113–148, 249–313Google Scholar
  39. 39.
    Mitchell EC, de la Torre E, Alexander E, Davis CH (1962) The nonfilling phenomenon during angiography in acute intracranial hypertension. Report of 5 cases and experimental study. J Neurosurg 19: 766–774PubMedGoogle Scholar
  40. 40.
    Miyake A, Aono T, Minagawa J, Kawamura Y, Kurachi K (1980) Changes in plasma luteinizing hormone-releasing hormone during clomiphene-induced ovulatory cycles. Fertil Steril 34: 172–174PubMedGoogle Scholar
  41. 41.
    Moosely JI, Molinari GF, Walder AE (1976) Respirator brain. Report of a survey and review of current concepts. Arch Pathol Lab Med 100: 61–64PubMedGoogle Scholar
  42. 42.
    Novitzky D, Cooper DKC, Reichart B (1987) Hemodynamics and metabolic responses to hormonal therapy in brain dead potential organ donors. Transplantation 43: 852–854PubMedGoogle Scholar
  43. 43.
    Outwater KM, Rockoff MA (1984) Diabetes insipidus accompanying brain death in children. Neurology (Cleveland) 34: 1243–1246Google Scholar
  44. 44.
    Petty GW, Mohr JP, Pedley TA, Tatemachi TK, Lennihan L, Duterte DI, Sacco RL (1990) The role of transcranial Doppler in confirming brain death. Sensitivity, specificity, and suggestions for performance and interpretation. Neurology 40: 300–303PubMedGoogle Scholar
  45. 45.
    Pia HW (1986) Brain death. Acta Neurochir (Wien) 82: 1–6Google Scholar
  46. 46.
    Powner DJ, Hendrich A, Lagler RG, Ng RH, Madden RL (1990) Hormonal changes in brain dead patients. Crit Care Med 18: 702–708PubMedGoogle Scholar
  47. 47.
    Pribram HFW (1961) Angiographic appearances in acute intracranial hypertension. Neurology 11: 10–21PubMedGoogle Scholar
  48. 48.
    Reid RH, Gulenchyn KY, Ballinger JR (1989) Clinical use of technetium-99 m HM-PAO for determintion of brain death. J Nucl Med 30: 1621–1626PubMedGoogle Scholar
  49. 49.
    Ries F, Moskopp D (1989) Value of transcranial Doppler ultrasound technique (TCD) for the determination of brain death. Neurosurg Rev 12 [Suppl 1]: 302–306PubMedGoogle Scholar
  50. 50.
    Riishede J, Ethelberg S (1953) Angiographic changes in sudden and severe herniation of brain tissue through tentorial incisura. Report of five cases. Arch Neurol Psychiatry 70: 399–409Google Scholar
  51. 51.
    Robertson KM, Hramiak IM, Gelb AW (1988) Thyroid function and haemodynamic stability after brain death. Can J Anaesth 35: S 102Google Scholar
  52. 52.
    Robertson KM, Hramiak IM, Gelb AW (1989) Endocrine changes and haemodynamics stability after brain death. Transplant Proc 21: 1197–1198PubMedGoogle Scholar
  53. 53.
    Robertson GL, Schelton RL, Athar S (1976) The osmoregulation of vasopressin. Kidney Int 10: 25–37PubMedGoogle Scholar
  54. 54.
    Ropper AH, Kehne SM, Wechler L (1987) Transcranial Doppler in brain death. Neurology 37: 1733–1735PubMedGoogle Scholar
  55. 55.
    Saito H, Saito S, Yamazaki R, Hosoi E (1984) Clinical value of radioimmunoassay of plasma growth-hormone-releasing factor. Lancet ii: 401–402Google Scholar
  56. 56.
    Schrader H, Krogness K, Aakvaag A, Sortland O, Purvis K (1980) Changes in pituitary hormones in brain death. Acta Neurochir (Wien) 52: 239–248Google Scholar
  57. 57.
    Schröder R (1983) Later changes in brain death. Signs of partial recirculation. Acta Neuropathol 62: 15–23PubMedGoogle Scholar
  58. 58.
    Schulte HM, Chrousos GP, Booth JD, Oldfield EH, Gold PW, Cutler Jr GB, Loriaux DL (1984) Corticotropin-releasing factor: pharmacokinetics in man. J Clin Endocrinol Metab 58: 192–196PubMedGoogle Scholar
  59. 59.
    Shibasaki T, Kiyosawa Y, Masuda A, Nakahara M, Imaki T, Wakabayashi I, Demura H, Shizume K, Ling N (1984) Distribution of growth hormone-releasing hormone like immunoreactivity in human tissue extracts. J Clin Endocrinol Metab 59: 263–268PubMedGoogle Scholar
  60. 60.
    Shibasaki T, Masuda A, Hotta M, Imaki T, Yamahuchi N, Kato Y, Demura H, Shizume K (1988) GRF and somtostatin in the regulation of GH secretion. In: Imura H (ed) Neuroendocrine control of the hypothalamo-pituitary system. Japan Scientific Societies Press, pp 151–157Google Scholar
  61. 61.
    Takeuchi K, Takeshita H, Takakura K, Shimazono Y, Handa H, Gotoh F, Manaka S, Shiogai T (1987) Evolution of criteria for determination of brain death in Japan. Acta Neurochir (Wien) 87: 93–98Google Scholar
  62. 62.
    Valenta LJ, De Feo DR (1980) Post-traumatic hypopituitarism due to a hypothalamic lesion. AJM 68: 614–617Google Scholar
  63. 63.
    Walker AE, Diamond AEL, Moosley J (1975) The neuropathological findings in irreversible coma. J Neuropathol Exp Neurol 34: 295–323PubMedGoogle Scholar
  64. 64.
    Watabe T, Tanaka K, Kumage M, Itoh S, Hasegawa M, Horiuchi T, Miyabe S, Ohno H, Shimizu N (1987) Diurnal rhythm of plasma immunoreactive corticotropin-releasing factor in normal subjects. Life Sci 40: 1651PubMedGoogle Scholar
  65. 65.
    Watabe T, Tanaka K, Kumage M, Itoh S, Takeda F, Morio K, Hasegawa M, Horiuchi T, Miyabe S, Shimizu N (1987) Hormonal response to insulin-induced hypoglycemia in man. J Clin Endocrinol Metab 65: 1187–1191PubMedGoogle Scholar
  66. 66.
    Welsch CW, Cassell SE, Chen CL, Meites J (1971) Median eminence lesions and serum prolactin: influence of ovarectomy and ergorine. Am J Physiol 221: 1714–1717PubMedGoogle Scholar
  67. 67.
    Yokota H, Nakazawa S, Shimura T, Kimura A, Yamamoto Y, Otsuka T (1991) Hypothalamic and pituitary function in brain death. Neurol Med Chir (Tokyo) 31: 881–886Google Scholar
  68. 68.
    Zurynski Y, Dorsch N, Pearson L, Smith F, Woods P (1989) The use of transcranial Doppler sonography in the diagnosis of brain death. J Neurosurg Anesthesiol 1: 323–327PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • K. Arita
    • 1
  • T. Uozumi
    • 1
  • S. Oki
    • 1
  • K. Kurisu
    • 1
  • M. Ohtani
    • 2
  • T. Mikami
    • 2
  1. 1.Department of NeurosurgeryHiroshima University School of MedicineHiroshimaJapan
  2. 2.Department of Emergency and Intensive Care MedicineHiroshima University School of MedicineHiroshimaJapan

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