Hypothalamic hormones as well as anterior pituitary hormones were detected in 
the peripheral plasma after the diagnosis of brain death. It is possible that 
residual hypothalamic tissue was functioning after satisfying the usual criteria 
of total brain death. To examine this possibility, endocrinological and 
morphological alterations of the hypothalamic-pituitary system was evaluated in 
28 brain dead patients. Intrinsic ADH was depleted in the plasma shortly after 
the diagnosis of brain death. Anterior pituitary hormones were initially 
detected in all patients, but gradually disappeared. The direct TRH (thyrotropin 
releasing hormone) stimulation to the anterior lobe was responded to well. 
Morphological studies showed a partial necrosis of the anterior lobe and the 
preservation of the posterior lobe for as long as a week. These data prove that 
the pituitary is partially preserved after brain death. LH-RH (luteinizing 
hormone releasing hormone) was detected in the peripheral plasma of all patients 
and GRF (growth hormone releasing factor) was detected in half of the patients 
for as long as 15 days, but autopsy revealed the fact that the brain tissue 
including the hypothalamus became extensively necrotic after the sixth day of 
brain death. In order to solve this controversy it is proposed that these 
hormones originate from extracranial tissues such as pancreas. The detection of 
hypothalamic hormones after the diagnosis of brain death therefore is not 
contradictory to the concept of total brain death.