Pituitary volume in psychosis

Pariante, Carmine M.; Vassilopoulou, Konstantina; Velakoulis, Dennis; Phillips, Lisa; Soulsby, Bridget; Wood, Stephen J.; Brewer, Warrick J.; Smith, Deidre J.; Dazzan, Paola; Yung, Alison R.; Zervas, Ioannis; Christodoulou, George N.; Murray, Robin M.; McGorry, Patrick D.; Pantelis, Christos

doi:10.1192/bjp.185.1.5

Cited by 163 publications

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“…Indeed, in patients with major depression, the volume of the pituitary correlates with the circulating cortisol levels (Axelson et al, 1992;Krishnan et al, 1991). Recently, we have described an increased volume of the pituitary gland, measured by magnetic resonance imaging (MRI), in 24 subjects with a first-episode of psychosis recruited in Melbourne, Australia (Pariante et al, 2004). This work supports the hypothesis that these patients have activation of the HPA axis.…”

Section: Introductionsupporting

confidence: 68%

“…Each pituitary was traced in all coronal slices where it could be visualized, using ANALYZE 7.5 (Mayo) with a method that has been used previously by us and others (MacMaster and Kusumakar, 2004;Pariante et al, 2004;Sassi et al, 2001). The pituitary stalk was excluded from the tracings, whereas we included a posterior bright spot, corresponding to the posterior pituitary (the intensity of which is thought to reflect vasopressin concentrations).…”

Section: Pituitary Measurementmentioning

confidence: 99%

“…We traced around the usually well-defined borders of anterior and posterior pituitary: the diaphragma sellae, superiorly; the sphenoid sinus, inferiorly; and the cavernous sinuses, bilaterally. Figure 1 shows these borders in a good-quality image from the original Australian sample in which we developed the measurement method (Pariante et al, 2004). Volume of the pituitary (in mm 3 ) was calculated by summing volumes for all relevant slices.…”

Section: Pituitary Measurementmentioning

confidence: 99%

“…We have previously shown that subjects at their first episode of psychoses show an enlarged volume of the pituitary gland, but it is still unclear whether this is due to activation of the hormonal stress response during the psychotic experience, or to stimulation of the prolactin-secreting cells by antipsychotic treatment (Cotter and Pariante, 2002;Pariante et al, 2004). Both old (Sachar et al, 1970) and recent studies (Ryan et al, 2003(Ryan et al, , 2004a have demonstrated hyperactivity of the main hormonal stress system, the hypothalamic-pituitary-adrenal (HPA) axis, in subjects experiencing their first psychotic episode.…”

Section: Introductionmentioning

confidence: 99%

“…In turn, HPA axis hyperactivityFin major depressionFhas been linked to an increased volume of the pituitary gland (Axelson et al, 1992;Krishnan et al, 1991;MacMaster and Kusumakar, 2004). The pituitary gland regulates HPA axis activity by secreting the adrenocorticotropic hormone (ACTH), and its increased volume has been interpreted as reflecting an increase in the size and number of corticotrope cells producing ACTH (Axelson et al, 1992;Krishnan et al, 1991;Pariante et al, 2004). Indeed, in patients with major depression, the volume of the pituitary correlates with the circulating cortisol levels (Axelson et al, 1992;Krishnan et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

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Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Pariante

Dazzan

Danese

et al. 2005

Neuropsychopharmacol

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Subjects at their first psychotic episode show an enlarged volume of the pituitary gland, but whether this is due to hypothalamicpituitary-adrenal (HPA) axis hyperactivity, or to stimulation of the prolactin-secreting cells by antipsychotic treatment, is unclear. We measured pituitary volume, using 1.5-mm, coronal, 1.5 T, high-resolution MRI images, in 78 patients at the first psychotic episode and 78 age-and gender-matched healthy controls. In all, 18 patients were antipsychotic-free (12 of these were antipsychotic-naïve), 26 were receiving atypical antipsychotics, and 33 were receiving typical antipsychotics. As hypothesized, patients had a larger pituitary volume than controls ( þ 22%, po0.001). When divided by antipsychotic treatment, and compared to controls, the pituitary volume was 15% larger in antipsychotic-free patients (p ¼ 0.028), 17% larger in patients receiving atypicals (p ¼ 0.01), and 30% larger in patients receiving typicals (po0.001). Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together ( þ 11%, p ¼ 0.08). When divided by diagnosis, and compared to controls, the pituitary volume was 24% larger in patients with schizophrenia/schizophreniform disorder (n ¼ 40, po0.001), 19% larger in depressed patients (n ¼ 13, p ¼ 0.022), 16% larger in bipolar patients (n ¼ 16, p ¼ 0.037), and 12% larger in those with other psychoses (n ¼ 9, p ¼ 0.2). In conclusion, the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presence of antipsychotic treatment, and this could be due to activation of the HPA axis. Typical antipsychotics exert an additional enlarging effect on pituitary volume, likely to be related to activation of prolactin-secreting cells. This activation of the hormonal stress response could participate to the important metabolic abnormalities observed in patients with psychosis.

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Section: Introductionsupporting

confidence: 68%

Section: Pituitary Measurementmentioning

confidence: 99%

Section: Pituitary Measurementmentioning

confidence: 99%