MORPHOLOGICAL AND FUNCTIONAL ALTERATIONS OF THE HYPOTHALAMIC-PITUITARY SYSTEM IN BRAIN-DEATH WITH LONG-TERM BODILY LIVING

Hypothalamic hormones as well as anterior pituitary hormones were dete cted in the peripheral plasma after the diagnosis of brain dealth. It is possible that residual hypothalamic tissue was functioning after sa tisfying the usual criteria of total brain death. To examine this poss ibility, endocrinological and morphological alterations of the hypotha lamic-pituitary system was evaluated in 28 brain dead patients. Intrin sic ADH was depleted in the plasma shortly after the diagnosis of brai n death. Anterior pituitary hormones were initially detected in all pa tients, but gradually disappeared. The direct TRH (thyrotropin releasi ng hormone) stimulation to the anterior lobe was responded to well. Mo rphological studies showed a partial necrosis of the anterior lobe and the preservation of the posterior lobe for as long as a week. These d ata prove that the pituitary is partially preserved after brain death. LH-RH (luteinizing hormone releasing hormone) was detected in the per ipheral plasma of all patients and GRF (growth hormone releasing facto r) was detected in half of the patients for as long as 15 days, but au topsy revealed the fact that the brain tissue including the hypothalam us became extensively necrotic after the sixth day of brain death. In order to solve this controversy it is proposed that these hormones ori ginate from extracranial tissues such as pancreas. The detection of hy pothalamic hormones after the diagnosis of brain death therefore is no t contradictory to the concept of total brain death.