Skip to main content

High incidence of decreased cortisol reserve in brain-dead potential organ-donors

To investigate the adrenocortical function in brain-dead, potential organ donors, 36 patients (27 men, 9 women) with severe brain injury (BI), having a mean age of 42 ± 18 years were studied. Group A, consisted of 20 BI patients who did not develop brain-death (BD), and group B, was comprised of 16 BI patients who became brain-dead. Of these, seven patients were admitted in the hospital after clinical BD. In all patients (group A and group B), a morning blood sample was obtained upon admission in the ICU to determine baseline plasma cortisol levels. Subsequently, 1 μg of corticotropin (ACTH, synacthen) was administered intravenously and a second blood sample was drawn 30 min following the injection. In group B patients, the same procedure was repeated the morning following the confirmation of BD. Patients having a cortisol level of at least 18 μg/dl following the administration of ACTH were defined as responders. After the occurrence of BD, group B patients had significantly lower values for baseline (8.8 ± 6.3 vs 17.0 ± 6.6 μg/dl, P < 0.001) and stimulated (16.8 ± 6.5 vs. 23.9 ± 5.7 μg/dl, P = 0.001) plasma cortisol levels compared to group A patients. Hormonal data of the nine brain-dead patients studied upon admission in the ICU and after the occurrence of BD were the following: baseline plasma cortisol 23.8 ± 12.0 vs 7.1 ± 4.3 μg/dl, P = 0.008, and stimulated plasma cortisol 28.9 ± 10.5 vs 16.0 ± 4.4 μg/dl, P = 0.01. Thirteen group B patients (81%) and two group A patients (10%) were non-responders to synacthen (P < 0.0001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r = 0.72, P = 0.002), whereas there was no correlation between baseline cortisol and the increment in cortisol (r =-0.33, P = 0.21). In conclusion, adrenal cortisol secretion following dynamic stimulation is deficient in a substantial proportion of brain-dead patients. This finding calls for reconsideration of corticosteroid replacement therapy, at least in a subset, of brain-dead potential organ donors.

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dimopoulou, I., Anthi, A., Milou, E. et al. High incidence of decreased cortisol reserve in brain-dead potential organ-donors. Crit Care 6, P225 (2002).

Download citation


  • Cortisol
  • Plasma Cortisol
  • Plasma Cortisol Level
  • Severe Brain Injury
  • Baseline Cortisol