Nishioka H, Ito H, Ikeda Y, Koike S, Ito Y
Department of Neurosurgery, Tokyo Medical College, Japan.
No To Shinkei. 1995 Dec;47(12):1159-63.
To evaluate the hypothalamic-adenohypophysial function of corticotropin releasing hormone (CRH)-ACTH system in brain death, basal serum values of ACTH and cortisol was measured, and in addition, insulin-tolerance test (ITT) and CRH stimulation test was performed is 28 brain death cases. Basal levels of ACTH were low-normal, whereas those of cortisol were high-normal, and no correlation was observed between them. There was no correlation between these levels and the age, sex, cause of the brain death, and the incidence of hypotention. However, basal ACTH value significantly decreased within a few days (p < 0.01), and ACTH was undetectable in all cases 5 days after the diagnosis of the brain death. On the other hand, ITT and CRH test was negative in all cases. These results suggest that some degree of adenohypophysial function of ACTH secretion remains for a few days after the diagnosis of the brain death. Compared with other adenohypophysial hormones of the brain death cases in previous reports, however, ACTH was lower, decreased more rapidly, and did not response to the direct pituitary stimulation test, the CRH test. These results further suggest that disturbance of ACTH secretion occurs from an early stage in the brain death cases.
为评估脑死亡时促肾上腺皮质激素释放激素（CRH）-促肾上腺皮质激素（ACTH）系统的下丘脑-腺垂体功能，测定了28例脑死亡患者的基础血清ACTH和皮质醇水平，此外还进行了胰岛素耐量试验（ITT）和CRH刺激试验。ACTH基础水平处于低正常范围，而皮质醇基础水平处于高正常范围，两者之间未观察到相关性。这些水平与年龄、性别、脑死亡原因及低血压发生率之间均无相关性。然而，基础ACTH值在数天内显著下降（p<0.01），在脑死亡诊断后5天所有病例中ACTH均检测不到。另一方面，所有病例的ITT和CRH试验均为阴性。这些结果表明，脑死亡诊断后数天内仍存在一定程度的腺垂体ACTH分泌功能。然而，与既往报道的脑死亡病例中的其他腺垂体激素相比，ACTH水平较低、下降更快，且对直接垂体刺激试验（CRH试验）无反应。这些结果进一步表明，脑死亡病例中ACTH分泌紊乱从早期就已发生。
