ANTERIOR AND POSTERIOR PITUITARY-FUNCTION IN BRAIN-STEM-DEAD DONORS - A POSSIBLE ROLE FOR HORMONAL REPLACEMENT THERAPY
ANTERIOR AND POSTERIOR PITUITARY-FUNCTION IN BRAIN-STEM-DEAD DONORS - A POSSIBLE ROLE FOR HORMONAL REPLACEMENT THERAPY
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DOI：
10.1097/00007890-198905000-00016
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发表时间：
1989-05-01
期刊：
影响因子：
6.2
通讯作者：
REES, LH
中科院分区：
文献类型：
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作者：
HOWLETT, TA;KEOGH, AM;REES, LH
在器官捐献时，从9个月期间被转介到一个移植协调员的31个连续的脑干死亡（BSD）供体中获得血液样本。24例病例（77%）有临床尿崩症（DI），大多数病例控制不佳，伴有明显脱水（血清渗透压范围268-357;中位数302 mOSM/kg）。血清三碘甲状腺原氨酸（T3）低于正常25例（81%），血清反T3均正常或偏高，血清游离甲状腺素（T4）指数低于正常9例（29%），TSH低于正常7例（23%）。在任何情况下，T4和TSH均低于正常，结果是典型的病态甲状腺功能正常综合征，而不是TSH缺乏症。在21例未接受皮质类固醇的病例中，5例（24%）的血清皮质醇高于550 nmol/L（20 μ g/dl），排除ACTH缺乏，只有1例的皮质醇水平检测不到。重度低血压患者血清皮质醇水平无明显降低（平均354 vs.416; P > 0.5）。催乳素、生长激素、促性腺激素和性腺类固醇的水平是可变的，但只有少数人明显缺乏这些激素。BSD捐赠者经常有DI，这通常是由非专家管理不善，需要适当的替代治疗。相反，大多数患者并不是完全缺乏垂体前叶激素。因此，从内分泌学角度来看，使用皮质醇和T3进行常规激素治疗是不合理的。只有在对照试验明确证明移植器官功能在临床上有显著改善，而不损害供体的情况下，才能广泛采用这种治疗方法。
Blood samples were obtained, at the time of organ donation, from 31 consecutive brain-stem-dead (BSD) donors referred to one transplant coordinator during a 9-month period. Twenty-four cases (77%) had clinical diabetes insipidus (DI), which was poorly controlled with marked dehydration in a majority of cases (serum osmolality range 268-357; median 302 mOSM/kg). serum triiodothyronine (T3) was subnormal in 25 (81%); all had normal or high serum reverse T3; and the serum free thyroxine (T4) index was subnormal in 9 (29%), and TSH was subnormal in 7 (23%). In no case were T4 and TSH both subnormal and results were typical of the sick euthyroid syndrome rather than TSH deficiency. Of 21 cases not receiving corticosteroids, 5 (24%) had a serum cortisol above 550 nmol/L (20 .mu.g/dl), excluding ACTH deficiency,and only 1 had undetectable cortisol levels. Those with severe hypotension did not have significantly lower serum cortisol (mean 354 vs. 416; P > 0.5). Levels of prolactin, growth hormone, gonadotrophins, and gonadal steroids were variable, but only a minority were frankly deficient in these hormones. BSD donors frequently have DI, which is often managed poorly by nonspecialists and requires appropriate replacement therapy. In contrast most patients are not totally deficient in anterior pituitary hormones. Routine hormonal therapy with cortisol and T3 cannot, therfore, be justified on endocrinological grounds. Widespread introduction of such treatment should only follow controlled trials that clearly demonstrate clinically significant improvements in the transplanted organ function, without detriment to the donor.