Arita K, Uozumi T, Oki S, Kurisu K, Ohtani M, Mikami T
Department of Neurosurgery, Hiroshima University School of Medicine, Japan.
Acta Neurochir (Wien). 1993;123(1-2):64-75. doi: 10.1007/BF01476288.
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.
为了明确下丘脑 - 垂体轴在脑死亡患者中的功能，对39例脑死亡患者测定了垂体和下丘脑激素浓度，并进行了多项垂体前叶释放试验。此外，同时进行了脑血流测量。在几乎所有病例中，垂体和下丘脑激素的血浓度均高于检测方法的灵敏度。垂体前叶释放试验表明，下丘脑的有效功能受到严重抑制，而垂体前叶的正常分泌机制在脑死亡患者中部分保留。下丘脑神经元的组织学变化即使在同一病例中也有所不同，从几乎难以检测到的幽灵细胞到近乎正常的细胞。尽管如脑血流检查所示，剩余的循环似乎不足以维持完整的下丘脑 - 垂体功能，但全身循环中存在下丘脑激素表明，这些激素是由即使在脑死亡诊断后仍保留的最小血流量从下丘脑释放并携带的。
