Endocrine stress reaction to surgery in brain-dead organ donors.
We studied the course of plasma levels of the stress markers adrenocorticotropic hormone (ACTH), cortisol, human growth hormone (h-GH), beta-endorphin, and prolactin during retrieval surgery in eleven brain-dead organ donors scheduled for multiple organ explantation. Donors were divided into two groups according to hemodynamic stability. Hormones demonstrated a great variability in plasma levels and in the pattern of reaction, revealing a different degree of remaining pituitary function. Beta-Endorphin was the only stress hormone that showed a response to surgical stimuli in six patients. Only three of them developed a concomitant rise in ACTH. Cortisol, prolactin, and h-GH plasma levels did not change during the observation period. In the three cases with a slight elevation in ACTH, no subsequent change in cortisol was detectable. Beta-Endorphin showed greater variability and a tendency to higher levels in the group presenting with a higher arterial pressure, which resulted in a significant difference (P < 0.005) when distributions were compared using the Mann-Whitney U-test. No correlation was found between hypotensive episodes and deficiencies of other stress hormones. We conclude that pituitary function varies considerably in brain-dead organ donors without demonstrating a correlation to the onset of hypotension. Thus, we feel no need for a substitution treatment with any of the hormones investigated prior to organ explanation.
Fitzgerald
R D
RD
Department of Anaesthesia and General Intensive Care, University of Vienna Medical School, Austria.
Dechtyar
I
I
Templ
E
E
Pernerstorfer
T
T
Hackl
W
W
Lackner
F X
FX
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001926:Brain Death / Q000378:metabolism*; D004702:Endocrine Glands / Q000378:metabolism*; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007022:Hypotension / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D013312:Stress, Physiological / Q000097:blood*; D009927:Tissue and Organ Procurement; D001615:beta-Endorphin / Q000097:blood
D001615:beta-Endorphin; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D013006:Growth Hormone; D006854:Hydrocortisone