Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
Psychoneuroendocrinology. 2010 Aug;35(7):1074-81. doi: 10.1016/j.psyneuen.2010.01.008. Epub 2010 Feb 19.
Many of the clinical and neuroendocrine features of bipolar disorder involve hypothalamic structures. Although current neuroimaging techniques inadequately resolve the structural components of the hypothalamus, evidence of derangement can be sought by examining the adjacent third ventricle and the functionally related pituitary.
To investigate the structure and function of the hypothalamic-pituitary-adrenal axis in euthymic patients with bipolar disorder.
Euthymic adult patients with bipolar disorder (n=49) were compared with matched normal control subjects (n=47). Pituitary volume and third ventricle width were assessed on MRI scans. Basal salivary cortisol levels were measured.
The width of the third ventricle in patients with bipolar disorder exceeded that of controls (mean +/- SD (in mm): 3.87 +/- 1.96 versus 2.56 +/- 1.34; d=0.76, ANOVA F=12.7, p=0.001), with the greatest differences found in males. Third ventricle width increased with age across the groups (F=16.97, p<0.001). Pituitary volumes did not differ between patients and controls (mean +/- SD (in mm(3)): 632 +/- 176 versus 679 +/- 159). Overall, females had larger pituitaries than males (703 +/- 160 versus 595 +/- 161; d=0.67, F=9.65, p=0.003; all subjects), but female patients had smaller pituitaries compared to female controls (637 +/- 178 versus 756 +/- 126; d=0.65, F=5.04, p=0.03). No difference was found in a comparable analysis of males. Pituitary volume did not differ between patients prescribed and not prescribed antipsychotic drugs. Basal salivary cortisol levels did not differ between patients and controls.
In euthymic patients with normal basal cortisol levels, pituitary volume and third ventricle width were found to differ from normal controls. These differences were related to gender, may be important in the pathogenesis of bipolar disorder and could link the vegetative and endocrine abnormalities seen in this condition. Such findings may reflect a trait abnormality or be a consequence of previous episodes.
许多双相情感障碍的临床和神经内分泌特征涉及下丘脑结构。尽管目前的神经影像学技术不能充分解析下丘脑的结构成分，但通过检查相邻的第三脑室和功能相关的垂体，可以寻找紊乱的证据。
研究双相情感障碍患者静息期下丘脑-垂体-肾上腺轴的结构和功能。
比较 49 例双相情感障碍成年患者和 47 例匹配的正常对照者。在 MRI 扫描上评估垂体体积和第三脑室宽度。测量基础唾液皮质醇水平。
双相情感障碍患者的第三脑室宽度大于对照组（平均值 +/- 标准差（mm）：3.87 +/- 1.96 对 2.56 +/- 1.34；d=0.76，方差分析 F=12.7，p=0.001），男性差异最大。第三脑室宽度随年龄在各组中增加（F=16.97，p<0.001）。患者和对照组的垂体体积无差异（平均值 +/- 标准差（mm(3))：632 +/- 176 对 679 +/- 159）。总体而言，女性的垂体大于男性（703 +/- 160 对 595 +/- 161；d=0.67，F=9.65，p=0.003；所有受试者），但女性患者的垂体小于女性对照组（637 +/- 178 对 756 +/- 126；d=0.65，F=5.04，p=0.03）。在对男性进行类似分析时，未发现差异。服用和未服用抗精神病药物的患者之间的垂体体积无差异。患者和对照组的基础唾液皮质醇水平无差异。
在基础皮质醇水平正常的静息期双相情感障碍患者中，发现垂体体积和第三脑室宽度与正常对照组不同。这些差异与性别有关，可能在双相情感障碍的发病机制中很重要，并可能将该疾病中观察到的植物神经和内分泌异常联系起来。这些发现可能反映了一种特质异常，或者是以前发作的结果。
