Pariante Carmine M
Section and Laboratory of Stress, Psychiatry and Immunology (SPI-Lab), Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London, UK.
J Psychopharmacol. 2008 Mar;22(2 Suppl):76-81. doi: 10.1177/0269881107084020.
The pituitary gland regulates hypothalamic-pituitary-adrenal (HPA) axis activity by secreting adrenocorticotropic hormone (ACTH), and HPA axis abnormalities have been described in psychosis. Moreover, the pituitary gland secretes prolactin, and some antipsychotics increase the secretion of this hormone. Therefore, it is possible that psychosis is associated with an abnormal volume of the pituitary, as a consequence of a dysfunction in either or both these hormonal systems. The present review of the studies conducted so far clearly indicates that the pituitary is a dynamic organ, which changes differently at different stages of the psychotic disorder, in response to both the disorder itself and the treatment with antipsychotics. Specifically, the pituitary is larger in the months immediately preceding or following the psychosis onset, independently from antipsychotic treatments. However, following this initial enlargement, the pituitary tends to become smaller, as suggested by studies in patients with psychosis of at least two years of duration. On top of these dynamic changes that are linked to the course of the disorder, antipsychotics, and especially antipsychotics inducing hyperprolactinaemia, exert additional enlarging effects on pituitary volume. We suggest that the increased pituitary volume associated with the development of psychosis is due to activation of the hormonal stress response and, specifically, to an increase in the size and number of corticotroph cells producing ACTH, while the increased pituitary volume induced by antipsychotics is linked to the stimulating effects of these drugs on lactotroph cells producing prolactin. Future studies should address these issues that are relevant in improving the care of patients with psychosis.
垂体通过分泌促肾上腺皮质激素（ACTH）来调节下丘脑 - 垂体 - 肾上腺（HPA）轴的活动，并且在精神病中已描述了HPA轴异常。此外，垂体分泌催乳素，一些抗精神病药物会增加这种激素的分泌。因此，由于这两种激素系统中一种或两种功能失调，精神病可能与垂体体积异常有关。目前对迄今为止所进行研究的综述清楚地表明，垂体是一个动态器官，在精神病性障碍的不同阶段会有不同变化，这是对疾病本身以及抗精神病药物治疗的反应。具体而言，在精神病发作前或后的几个月中，垂体较大，与抗精神病药物治疗无关。然而，在这种最初的增大之后，垂体往往会变小，至少持续两年的精神病患者的研究表明了这一点。除了这些与疾病进程相关的动态变化之外，抗精神病药物，尤其是引起高催乳素血症的抗精神病药物，对垂体体积有额外的增大作用。我们认为，与精神病发展相关的垂体体积增加是由于激素应激反应的激活，特别是产生ACTH的促肾上腺皮质激素细胞的大小和数量增加，而抗精神病药物引起的垂体体积增加与这些药物对产生催乳素的催乳素细胞的刺激作用有关。未来的研究应解决这些与改善精神病患者护理相关的问题。
