Endocrine Changes

In the baboon, following induction of brain death, a rapid disintegration of the endocrine system has been observed. The loss of the hypothalamic-hypophyseal function results in reduction or cessation of antidiuretic hormone (ADH) production, which is followed by diabetes insipidus.3

Following the adrenergic storm, plasma levels of various hormones become reduced. There is a rapid reduction of ACTH, growth hormone, cortisol and insulin.3

The thyroid profile falls within the typical plasma level profile of the Euthy-roid sick syndrome (ESS).15 The thyroid stimulating hormone remains unchanged or slightly reduced (Fig. 3.8). The total thyroxine (T4) and free triiodothyronine

Fig. 3.8. Plasma free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) following induction of brain death in the baboon. The mean values and the standard error of the mean are shown.

(FT3) are markedly reduced. There is a marked increment of reverse T3 (rT3). In a healthy state, 90% of the thyroid gland hormone production is released as T4, a prohormone. In peripheral tissues, T4 is converted into T3 as the active hormone.16 The ESS is the result of catecholamine activation of a tissue monodeiodinase converting the thyroid produced T4 into rT3 rather than T3. This is considered to be an adaptive beneficial response to stress. The current thought is that in acute states, thyroid hormone replacement should not be administered. However, our experience in the laboratory and in clinical studies clearly has shown beneficial results of T3 replacement.

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