[Hypothalamic-adenohypophysial function of corticotropin releasing hormone (CRH)-ACTH system in hypoxic coma]

To evaluate the hypothalamic-adenohypophysial function of corticotropin releasing hormone (CRH)-ACTH system in severe hypoxic coma, basal serum values of ACTH and cortisol was measured, and insulin-tolerance test (ITT) and CRH stimulation test was performed in 15 cases. They were divided into two groups according to their prognosis: brain death (group A, 7 cases) and persistent vegetative state (group B, 8 cases). Basal values were within normal range in most cases apart from those measured in few days after the brain death, however, stimulation tests were negative in many cases. In group A, basal values in impending stage were significantly higher han those after the brain death (p < 0.05), however, both stimulation tests were negative regardless of the stage. In group B, basal values in acute stage, which was measured within a week after the hypoxia, were slightly higher (without significance) than those in chronic stage, which was measured more than a months after the hypoxia. CRH test and ITT were positive in 0/4 and 2/5 in acute stage, and in 4/8 and 3/8 in chronic stage, respectively. In early stage of group A, the impending stage, showed slightly higher basal values than those in acute stage of group B (without significance). ITT was negative in the former whereas positive in some cases (2/5) of the latter, however, CRH test was negative in both groups. These results suggest that endocrinological evaluation of the hypothalamic-adenohypophysial function may help to predict outcome in early stage of hypoxic coma.