Hormonal changes in brain dead patients

Powner, David J.; Hendrich, Ann; Lagler, R G; Ng, Ronald H.; Madden, Robert L.

doi:10.1097/00003246-199007000-00004

Cited by 126 publications

(64 citation statements)

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“…In the present study, blood glucose levels were found to be substantially higher in the BD group than in SBL, which could be due to the rapid infusion of enriched glucose solutions utilized for fluid and electrolyte replacement and to the presence of an endocrinal failure, Indeed, many authors 4,5,24 have confirmed that endocrinal failure actually occurs in BD, and that hormonal replacement is necessary to retard hole body cell death. Novitzky et al 5 and Mariot et al 25 recorded a significant reduction in some hormones, mainly free triodotyronine, cortisol and insulin, in brain dead patients.…”

Section: Discussionsupporting

confidence: 48%

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Cintra

Maciel

Araújo

et al. 2004

Arq. Neuro-Psiquiatr.

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-Introduction: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. Objective: To evaluate AVP serum levels in SBL and BD patients. Design: Prospective, open label, observational trial. Setting: A general teaching hospital. Method:Three groups of adult subjects (age ≥ 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS) ≤8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. Results: AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. Conclusions: The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.KEY WORDS: brain lesion, brain death, vasopressin. Níveis séricos de arginina vasopressina em pacientes com lesão cerebral grave e em pacientes com morte encefálicaRESUMO -Introdução: Pacientes com lesão cerebral grave (LCG) ou com morte encefálica (ME) freqüentemente apresentam alterações na secreção de vasopressina (AVP). Objetivo: Avaliar os níveis séricos de AVP em pacientes com LCG e ME. Desenho: Estudo prospectivo, aberto, observacional. Local: Um hospital geral universitário. Método: Sujeitos adultos (idade ≥18 anos), de ambos os sexos, foram divididos em três grupos: grupo controle: 29 voluntários sadios; grupo LCG: 17 pacientes com pontuação na Escala de Coma de Glasgow (ECG) ≤8; grupo ME: 11 pacientes com diagnóstico de ME.Amostras de sangue venoso foram colhidas pela manhã, em repouso, nos pacientes do grupo controle, e de 8/8h, por 24h, nos pacientes dos grupos LCG e ME, para dosagens de AVP. Variáveis clínicas e laboratoriais de interesse foram anotadas concomitantemente. Resultados: Os valores da AVP (pg/ml) foram [média (DP); mediana]: grupo controle [2,2(1,1); 2,0]; grupo LCG [5,7(6,3); 2,9] e grupo ME [2,6(1,0); 2,8]. Observouse maior variação dos níveis séricos de AVP no grupo LCG, mas sem diferença estatisticamente significativa em relação aos demais (p=0,06). Hipotensão (p=0,02), hipernatremia (p=0,0001), hiperosmolaridade sérica (p=0,0001) e hiposmolaridade urinária (p=0,003) foram proeminentes no grupo ME em relação ao grupo LCG. Con...

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Section: Discussionsupporting

confidence: 48%

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Cintra

Maciel

Araújo

et al. 2004

Arq. Neuro-Psiquiatr.

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“…Postmortem prolactin levels are similar to antemortem values (30)(31)(32). In one study, prolactin levels measured shortly after a seizure and 1 week later, having been stored at room temperature, were about the same (33).…”

Section: Discussionsupporting

confidence: 72%

Prolactin Levels in Sudden Unexpected Death in Epilepsy

Opeskin

Clarke²,

Berkovic

2000

Epilepsia

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- Summary:Purpose: To assess serum prolactin levels in sudden unexpected death in epilepsy (SUDEP) and control groups to test the hypothesis that if seizures occur routinely as a terminal event in SUDEP, then raised prolactin levels may be an indicator of terminal seizure.Methods: Blood was taken for measurement of prolactin levels from subjects with SUDEP and three control groups. The control groups were those with epilepsy dying from causes other than epilepsy (e.g., ischemic heart disease or injuries), physiologically stressed individuals without epilepsy (they were admitted to the hospital after an acute illness and died after several hours to 3 days), and nonepileptic rapid deaths (these people collapsed suddenly and died at the scene). In the SUDEP group, evidence for terminal seizure was considered to be at least one of the following: body found half on, half off the bed, or urinary incontinence at the scene, or bitten lips or tongue at autopsy.The majority of sudden unexpected deaths in epilepsy (SUDEP) are unwitnessed, and in the absence of a better explanation, death is believed to be the result of a seizure. Clinical evidence for terminal seizure is found in up to about a third of cases (1-5), but whether seizures (either witnessed or unwitnessed) always precede SU-DEP is unknown.Serum prolactin has been observed to increase after generalized tonicklonic seizures (6-10) and complex partial seizures (8,ll-16), and the mechanism by which seizures are proposed to cause prolactin elevation involves propagation of the electrical discharge to the hypothalamus, thereby influencing prolactin release (16). Generally serum prolactin does not rise after simple partial or pseudoseizures (8,9,15,17,18 Results: There was evidence for terminal seizure at the scene or at autopsy in four of the 10 SUDEP cases. Serum prolactin levels were not significantly increased in the SUDEP group compared with the controls. None of the SUDEP subjects, including those with clinical evidence of a terminal seizure, had high prolactin levels characteristic of those observed after seizures in living subjects.Conclusions: Prolactin levels are not raised in SUDEP, even if there is evidence of terminal seizure. As prolactin takes 15-20 min to peak after a seizure in life, there may be insufficient time for a prolactin increase to occur in SUDEP. Thus prolactin levels cannot be used to determine if a deceased individual with epilepsy had a seizure or to answer the broad question whether SUDEP is always associated with a terminal seizure. Key Words: Prolactin-Epilepsy-Sudden unexpected death.The purpose of this study was to examine prolactin levels in SUDEP and control groups. If prolactin was consistently increased in SUDEP cases, but not in controls, then we would infer that terminal seizui-es had occurred in the SUDEP group.

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“…Moreover, there has been inconsistent improvement in physiological parameters after replacement of these hormones in both animals and humans. 24,59,60,[62][63][64][65] Vasopressin produces its physiological effects through three different receptors: V1, V2, and V3. 66 The V1 receptors are located within blood vessels and mediate the vasopressor effect.…”

Section: Temporal Considerationsmentioning

confidence: 99%

Traitement médical pour optimaliser le potentiel de don d’organe : une revue documentaire

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

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Hormonal changes in brain dead patients

Cited by 126 publications

References 0 publications

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Prolactin Levels in Sudden Unexpected Death in Epilepsy

Traitement médical pour optimaliser le potentiel de don d’organe : une revue documentaire

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