The Hypophysis in Patients withComa Dépassé("Respirator Brain")

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Abstract
The hypophyses of 25 patients with coma dépassé and "respirator brain" syndrome showed pathologic alterations. The mildest of these was karyopyknosis of acidophils. Severe, extensive pyknosis of large portions of the adenohypophysis with detachment of cells from basement membranes was the most common lesion. Acidophils appeared the most severely damaged, β2 cells the least. In other instances, sometimes along with karyopyknoticdesquamative changes, infarcts of the adenohypophysis occurred, with or without neurohypophysial malacia. In many of the patients brain lesions in addition to "respirator brain" were present. Karyopyknotic-desquamative alterations of the pituitary occurred as frequently with additional brain damage as in its absence. A narrow outer shell of the pars distalis was usually intact. Neurosecretion was frequently abundant (defective release?). The pituitary alterations in conjunction with "respirator brains" are ascribed to increased intracranial pressure, and their distribution, to the dual blood supply of the hypophysis.

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