High prevalence of decreased cortisol reserve in brain-dead potential organ donors.
OBJECTIVE
To investigate the adrenocortical function in brain-dead patients, potential organ donors.


METHODS
Prospective study.


METHODS
Intensive care units in two teaching hospitals.


METHODS
A total of 37 patients (28 men, nine women) with severe brain injury, having a mean age of 42 +/- 18 yrs, were included in the study. Group A consisted of 20 brain-injured patients who did not deteriorate to brain death. Group B included 17 brain-injured patients who were brain dead; of these, ten patients developed brain death during ICU stay and seven patients were admitted to the ICU after clinical brain death.


METHODS
In all patients (group A and group B), a morning blood sample was obtained at admission to the ICU to determine baseline plasma cortisol. Subsequently, 1 microg of corticotropin (adrenocorticotropic hormone, Synacthen) was administered intravenously, and a blood sample was taken 30 mins after the injection. In group B patients who became brain dead while being treated in the ICU (n = 10), the same procedure was repeated the morning after the confirmation of brain death. Patients having a cortisol level of at least 18 microg/dL after the administration of adrenocorticotropic hormone were defined as responders.


RESULTS
After the occurrence of brain death, group B patients had significantly lower values for baseline (8.5 +/- 6.2 vs. 17.0 +/- 6.6 microg/dL, p <.001) and stimulated (16.9 +/- 6.3 vs. 23.9 +/- 5.7 microg/dL, p =.001) plasma cortisol compared with group A patients. Thirteen group B patients (76%) and two group A patients (10%) were nonresponders to adrenocorticotropic hormone (p <.001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r =.71, p =.001), whereas there was no correlation between baseline cortisol and the increment in cortisol (r = -.37, p =.15). Mean hormonal data of the ten brain-dead patients studied at admission in the ICU and after the occurrence of brain death were the following: baseline plasma cortisol (23.5 +/- 11.4 vs. 6.8 +/- 4.2 microg/dL, p =.003) and stimulated serum cortisol (28.8 +/- 9.9 vs. 16.3 +/- 4.3 microg/dL, p =.008).


CONCLUSIONS
Adrenal cortisol secretion after dynamic stimulation is deficient in a substantial proportion of brain-dead potential organ donors.
Dimopoulou
Ioanna
I
Departments of Critical Care Medicine, Evangelismos Hospital, Athens, Greece. idimo@otenet.gr
Tsagarakis
Stylianos
S
Anthi
Anastasia
A
Milou
Ema
E
Ilias
Ioannis
I
Stavrakaki
Krystallia
K
Charalambidis
Charalambos
C
Tzanela
Marinella
M
Orfanos
Stylianos
S
Mandragos
Konstantinos
K
Thalassinos
Nikolaos
N
Roussos
Charis
C
D000293:Adolescent; D000304:Adrenal Cortex Function Tests; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000097:blood*; D001930:Brain Injuries / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone