Top

Hormones

Published in:

22-09-2023 | Original Article

Alterations in neuroendocrine axes in brain-dead patients

Authors: Türkay Akbaş, Ayhan Öztürk

Published in: Hormones | Issue 4/2023

Abstract

Purpose

To identify changes in anterior pituitary gland hormone levels in brain-dead patients and alterations in free triiodothyronine (fT3), free thyroxine, cortisol, testosterone, and estradiol levels.

Methods

Ten postmenopausal women and 22 men with brain death (BD) were included. The first blood sample for determination of hormones (pre-BD) was collected when the clinician observed the first signs of BD. The second blood sample (BD day) was drawn after BD certification.

Results

Female patients exhibited lower follicle-stimulating hormone and prolactin levels pre-BD and luteinizing hormone, follicle-stimulating hormone, and prolactin levels on BD day than the age-matched controls. Male patients’ sex hormone levels were similar to those of the age-matched controls, except for testosterone levels, which were low in both consecutive measurements. All gonadotropins and prolactin levels were above the tests’ lower detection limits (LDLs), except for one male patient with gonadotropin levels below the LDLs of the tests. Estradiol levels in both sexes ranged from normal to elevated. FT3 levels were significantly decreased in the two measurements. Thyroid-stimulating hormone (TSH) levels were low in eight patients and all low TSH levels were above the test’s LDL. The remaining patients had normal or elevated TSH levels. The median adrenocorticotropic hormone (ACTH) and cortisol levels were within normal limits. All cortisol and ACTH levels were above the tests’ LDLs, except for one patient with ACTH levels below the LDL in both measurements.

Conclusion

This study supports the hypothesis that the anterior pituitary gland continues to function in the brain-dead state.

Arita K, Uozumi T, Oki S, Kurisu K, Ohtani M, Mikami T (1993) The function of the hypothalamo-pituitary axis in brain dead patients. Acta Neurochir (Wien) 123:64–75. https://doi.org/10.1007/BF01476288 CrossRefPubMed

Sugimoto T, Sakano T, Kinoshita Y, Masui M, Yoshioka T (1992) Morphological and functional alterations of the hypothalamic-pituitary system in brain death with long term bodily living. Acta Neurochir (Wien) 115:31–36. https://doi.org/10.1007/BF01400587 CrossRefPubMed

Schrader H, Krogness K, Aakvaag A, Sortland O, Purvis K (1980) Changes of pituitary hormones in brain death. Acta Neurochir (Wien) 52:239–248. https://doi.org/10.1007/BF01402079 CrossRefPubMed

Ishikawa T, Michiue T, Quan L, Zhao D, Komatsu A (2009) Morphological and functional alterations in the adenohypophysis in cases of brain death. Leg Med (Tokyo) 11(Suppl 1):S234–S237. https://doi.org/10.1016/j.legalmed.2009.03.005 CrossRefPubMed

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 47:828–834. https://doi.org/10.1097/00007890-198905000-00016 CrossRefPubMed

Hohenegger M, Vermes M, Mauritz W, Redl G, Sporn P, Eiselsberg P (1990) Serum vasopressin (AVP) levels in polyuric brain-dead organ donors. Eur Arch Psychiatr Neurol Sci 239:267–269. https://doi.org/10.1007/BF01738582 CrossRef

Keogh AM, Howlett TA, Perry L, Rees LH (1988) Pituitary function in brain-stem dead organ donors: A prospective survey. Transplant Proc 20(5):729–730 PubMed

Gramm HJ, Meinhold H, Bickel U, Zimmermann J, von Hammerstein B, Keller F, Dennhardt R, Voigt K (1992) Acute endocrine failure after brain death? Transplantation 54(5):851–857. https://doi.org/10.1097/00007890-199211000-00016 CrossRefPubMed

Hall GM, Mashiter K, Lumley J, Robson JG (1980) Hypothalamic-pituitary function in “brain-dead” patients. Lancet 2(8206):1259. https://doi.org/10.1016/s0140-6736(80)92532-5 CrossRefPubMed

10.

Spratt DI, Longcope C, Cox PM, Bigos ST, Wilbur-Welling C (1993) Differential changes in serum concentrations of androgens and estrogens (in relation with cortisol) in postmenopausal women with acute illness. J Clin Endocrinol Metab 76(6):1542–1547. https://doi.org/10.1210/jcem.76.6.8501162 CrossRefPubMed

11.

Christeff N, Benassayag C, Carli-Vielle C, Carli A, Nunez EA (988) Elevated oestrogen and reduced testosterone levels in the serum of male septic shock patients. J Steroid Biochem 29(4):435–440. https://doi.org/10.1016/0022-4731(88)90254-3.

12.

Spratt DI, Morton JR, Kramer RS, Mayo SW, Longcope C, Vary CP (2006) Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization. Am J Physiol Endocrinol Metab 291(3):E631–E638. https://doi.org/10.1152/ajpendo.00467.2005 CrossRefPubMed

13.

Spratt DI (2001) Altered steroidogenesis in critical illness: is treatment with anabolic steroids indicated? Best Pract Res Clin Endocrinol Metab 15:479–494. https://doi.org/10.1053/beem.2001.0165 CrossRefPubMed

14.

Xiong Y, Hales DB (1993) The role of tumor necrosis factor-alpha in the regulation of mouse Leyding cell steroidogenesis. Endocrinol 132:2438–2444. https://doi.org/10.1210/endo.132.6.8504748 CrossRef

15.

Guo H, Calkins JH, Sigel MM, Lin T (1990) Interleukin-2 is a potent inhibitor of Leydig cell steroidogenesis. Endocrinol 127:1234–1239. https://doi.org/10.1210/endo-127-3-1234 CrossRef

16.

Van der Poll T, Romijn JA, Endert E, Sauerwein HP (1993) Effects of tumor necrosis factor on the hypothalamic-pituitary-testicular axis in healthy men. Metabolism 42:303–307. https://doi.org/10.1016/0026-0495(93)90078-3 CrossRefPubMed

17.

Choi YS, Na S, Kang SY, Koh SO (2008) Hormonal changes of the brain dead organ donors: A 3 year experience. Korean J Crit Care Med 23(1):30–35 CrossRef

18.

Harms J, Isemer FE, Kolenda H (1991) Hormonal alteration and pituitary function during course of brain stem death in potential organ donors. Transplant Proc 23(5):2614–2616 PubMed

19.

Peeters RP, Wouters PJ, Kaptein E, van Toor H, Visser TJ, van den Berghe, (2003) Reduced activation and increased inactivation of thyroid hormone in tissue of critically ill patients. J Clin Endocrinol Metab 88(7):3202–3211. https://doi.org/10.1210/jc.2002-022013 CrossRefPubMed

20.

Powner DJ, Hendrich A, Lagler RG, Ng RH, Madden RL (1990) Hormonal changes in brain dead patients. Crit Care Med 18(7):702–708. https://doi.org/10.1097/00003246-199007000-00004 CrossRefPubMed

21.

Masson F, Thicoïpe M, Latapie MJ, Maurette P (1990) Thyroid function in brain-dead donors. Transplant Int 3:226–233. https://doi.org/10.1007/BF00366971 CrossRef

22.

Téblick A, Langouche L, Van den Berge G (2019) Anterior pituitary function in critical illness. Endocr Connect 18(8):R131–R143. https://doi.org/10.1530/EC-19-0318 CrossRef

Title: Alterations in neuroendocrine axes in brain-dead patients
Authors: Türkay Akbaş
Ayhan Öztürk
Publication date: 22-09-2023
Publisher: Springer International Publishing
Published in: Hormones / Issue 4/2023
Print ISSN: 1109-3099
Electronic ISSN: 2520-8721
DOI: https://doi.org/10.1007/s42000-023-00489-9

Webinar | 08-11-2023 | 18:00 (CET)

Keynote Webinar | Spotlight on Diet and Diabetes

Watch now

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. Highlights include discussion of the recent EASD guidelines, therapeutic diets, food types and processing, plus psychological factors that influence patient success, and the drivers of healthy eating and diabetes control.

Prof. Mike Lean

Prof. Falko Sniehotta

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2023

Obituary: Professor Menelaos Batrinos (1926–2022)

A roadmap to medical nutrition therapy in type 2 diabetes

Investigating idiopathic central diabetes insipidus

“You are my sunshine, my only sunshine”: maternal vitamin D status and supplementation in pregnancy and their effect on neonatal and childhood outcomes

Flash glucose monitoring system in gestational diabetes: a study of accuracy and usability

The impact of classical music on anxiety and pain perception during a thyroid fine needle aspiration biopsy

Keynote Webinar | Spotlight on Diet and Diabetes