Endocrine & Metabolic System
- Failure of hypothalamic-pituitary axis due to ischaemia with:
- Impairment of temperature regulation
- ADH depletion:
- Diabetes insipidus (DI) which occurs in up to 65% of organ donors
- Characterised by diuresis, hypovolaemia, plasma hyperosmolality and hypernatremia
- ACTH depletion:
- Reductions in cortisol production are unrelated to the degree of hypotension but may impair the stress response
- TSH depletion:
- Reductions in the circulating levels of tri-iodothyronine (T3) and thyroxine (T4)
- Insulin depletion:
- Contributes to the development of hyperglycemia
- Aggravated by
- Administration of large volumes of glucose containing fluids, if used to treat hypernatremia
- Increased levels of catecholamines
- Inflammatory mediators released from damaged brain
- Generalized ischaemia– reperfusion (IR) injury
- Metabolic changes at the time of the catecholamine storm