Summary
Hypothalamic hormones as well as anterior pituitary hormones were detected in the peripheral plasma after the diagnosis of brain death. It is possible that residual hypothalamic tissue was functioning after satisfying the usual criteria of total brain death. To examine this possibility, endocrinological and morphological alterations of the hypothalamic-pituitary system was evaluated in 28 brain dead patients. Intrinsic ADH was depleted in the plasma shortly after the diagnosis of brain death. Anterior pituitary hormones were initially detected in all patients, but gradually disappeared. The direct TRH (thyrotropin releasing hormone) stimulation to the anterior lobe was responded to well. Morphological studies showed a partial necrosis of the anterior lobe and the preservation of the posterior lobe for as long as a week. These data prove that the pituitary is partially preserved after brain death.
LH-RH (luteinizing hormone releasing hormone) was detected in the peripheral plasma of all patients and GRF (growth hormone releasing factor) was detected in half of the patients for as long as 15 days, but autopsy revealed the fact that the brain tissue including the hypothalamus became extensively necrotic after the sixth day of brain death. In order to solve this controversy it is proposed that these hormones originate from extracranial tissues such as pancreas. The detection of hypothalamic hormones after the diagnosis of brain death therefore is not contradictory to the concept of total brain death.
Similar content being viewed by others
References
Christofiedes 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: 747–751
Forhman LA, Downs TR (1986) Measurement of growth hormone-releasing factor. Meth Enzym 124: 371–384
Guillemin R, Brazeau P, Boelen P, Esch F, Brazeau P, Ling N, Wehrenberg W (1982) Growth hormone-releasing factor from a human pancreatic tumor that caused acromegaly. Science 218: 585–587
Hall GM, Mashiter K, Jumley J, Robson JR (1980) Hypothalamic-pituitary function in the “brain-dead” patient. Lancet 2: 1259
Howlett TA, Keogh AM, Perry L, Touzel R, Rees LH (1989) Anterior and posterior pituitary function in brain-stem-dead donors. A possible role for hormonal replacement therapy. Transplantation 47: 828–34
Jeffcoate SL, Fraser HM, Holland DT, Gunn A (1974) Radioimmunoassay of luteinizing hormone-releasing hormone (LH-RH) in serum from man, sheep and rat. Acta Endocrinol 75: 625–635
Keren G, Barzilary Z, Schreiber M, Szeinberg A, Aladjem M (1982) Diabetes insipidus indicating a dying brain (letter). Crit Care Med 10: 798
Kinoshita Y, Okamoto K, Yahata K, Yoshioka T, Sugimoto T, Kawaguchi N, Onishi S (1990) Clinical and pathological changes of the heart in brain death maintained with vasopressin and epinephrine. Path Res Pract 186: 173–179
Kinshita Y, Yahata K, Yoshioka T, Onishi S, Sugimoto T (1990) Long-term renal preservation after brain death maintained with vasopressin and epinephrine. Transplant Int 3: 15–18
Leclercq TA, Crisoli F (1982) Arterial blood supply of the normal human pituitary gland. An anatomical study. J Neurosurg 58: 678–681
McCormick WF, Halmi NS (1970) The hypophysis in patients with coma dépassé (“Respirator Brain”). Clin Pathol 54: 374–383
McCornell EM (1953) The arterial blood supply on the human hypophysis cerebri. Anat Rec 115: 175–201
Miyake A, Kawamura Y, Aono T, Kurachi K (1980) Changes in plasma LRH during the normal menstrual cycle in women. Acta Endocrinol 93: 257–263
Nagareda T, Kinoshita K, Tanaka A, Hasuike Y, Terada N, Nishizawa Y, Fujita MQ, Kuroda H, Yawata K, Aozasa K, Sakano T, Sugimoto T, Kotoh K (1989) Clinicopathological study of livers from brain-dead patients treated with a combination of vasopressin and epinephrine. Transplantation 47: 792–797
Pallis C (1985) Diabetes insipidus with brain death [letter]. Neurology 35: 1086–1087
Report of the medical consultants on the diagnosis of death to the president's commission for the study of ethical problems in medicine and biomedical and behavioral research: (1981) Guidelines for the determination of death. JAMA 246: 2184–2186
Saito H, Saito S, Yamazaki R, Hosoi E (1984) Clinical value of radioimmunoassay of plasma growth hormone-releasing factor. Lancet 18: 401–402
Schrader H, Krogness K, Aakvaag A, Sortland O, Purvis K (1980) Changes of pituitary hormones in brain death. Acta Neurochir (Wien) 52: 239–248
Sugimoto T, Sadamitsu D, Sawada Y (1985) Criteria for the diagnosis of brain death: Report of the committee for investigation of brain death in Osaka university, school of medicine. Med J Osaka Univ 36: 29–34
Weindl A, Sofroniew M (1985) Neuroanatomical pathways related to vasopressin. In: Ganten D, Pfaff D (eds) Neurobiology of vasopressin. Current topics in neuroendocrinology, Vol 4. Springer, Berlin Heidelberg New York, pp 138–195
Yoshioka T, Sugimoto H, Uenishi M, Sakamoto T, Sadamitsu D, Sakano T, Sugimoto T (1989) Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: A clinical study. Neurosurgery 18: 565–567
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sugimoto, T., Sakano, T., Kinoshita, Y. et al. Morphological and functional alterations of the hypothalamic-pituitary system in brain death with long term bodily living. Acta neurochir 115, 31–36 (1992). https://doi.org/10.1007/BF01400587
Issue Date:
DOI: https://doi.org/10.1007/BF01400587