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Hypothalamic function in patients diagnosed as brain dead and its practical consequences.

Michael Nair-Collins1, Ari R Joffe2

  • 1Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States.

Handbook of Clinical Neurology
|July 16, 2021
PubMed
Summary
This summary is machine-generated.

Brain death diagnosis may not fully capture the absence of all brain function, as some patients show continued neuroendocrine activity. This challenges current brain death testing and management protocols.

Keywords:
Brain deathBrainstem deathDiabetes insipidusHormone replacement therapyHypothalamusPituitary

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Area of Science:

  • Neuroscience
  • Endocrinology
  • Medical Diagnostics

Background:

  • Brain death is a clinical diagnosis based on neurologic criteria.
  • Some patients declared brain dead exhibit residual neuroendocrine functions.
  • This phenomenon complicates the definitive diagnosis of brain death.

Purpose of the Study:

  • To review the pathophysiology of brain death concerning neuroendocrine function.
  • To examine evidence of continued hypothalamic function post-brain death declaration.
  • To discuss implications for brain death testing and management.

Main Methods:

  • Literature review of studies on brain death and neuroendocrine function.
  • Analysis of potential mechanisms for preserved hypothalamic activity.
  • Discussion of clinical management strategies.

Main Results:

  • Evidence suggests continued hypothalamic-pituitary function in some brain-dead patients.
  • Pathophysiology can lead to either neuroendocrine failure or preservation.
  • These findings introduce confounds in brain death assessment.

Conclusions:

  • Continued neuroendocrine function challenges the completeness of brain death criteria.
  • Further research is needed to understand and manage these cases.
  • Management strategies for hypothalamic-pituitary failure in brain death require consideration.