Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark.
Psychoneuroendocrinology. 2011 Jan;36(1):19-27. doi: 10.1016/j.psyneuen.2010.05.007. Epub 2010 Jun 19.
Numerous studies have shown that the hypothalamic-pituitary-adrenal (HPA) axis is hyperactive in some depressed patients. It is unclear whether such hyperactivity results in changed volumes of the adrenal glands, pituitary gland and hypothalamus. We systematically reviewed all controlled studies on the adrenal or pituitary glands or hypothalamus volume in unipolar depressive disorder published in PubMed 1966 to December 2009. We identified three studies that investigated the volume of the adrenal glands and eight studies that examined the volume of the pituitary gland, but no studies on hypothalamus were found. Two out of three studies found a statistically significant increase in adrenal volume in patients compared to controls. Four out of eight studies found a statistically significant increase in pituitary volume in patients compared to controls. Different methodological problems were identified such as small population samples, different subtypes of depression and insufficient matching of patients and controls. Due to large heterogeneity of study designs and data, it was futile to make a meta-analysis. It is concluded that it remains unclear whether hyperactivity of the HPA axis results in enlarged adrenal and pituitary glands and it is suggested that prospective studies should be conducted with scanning during successive depressive episodes and periods of remission.
大量研究表明，在下丘脑-垂体-肾上腺（HPA）轴在一些抑郁患者中过度活跃。目前尚不清楚这种过度活跃是否会导致肾上腺、垂体和下丘脑体积的变化。我们系统地回顾了 1966 年至 2009 年 12 月在 PubMed 上发表的所有关于单相抑郁障碍肾上腺或垂体或下丘脑体积的对照研究。我们确定了三项研究调查了肾上腺的体积，八项研究检查了垂体的体积，但没有发现关于下丘脑的研究。三项研究中有两项发现患者的肾上腺体积与对照组相比有统计学上的显著增加。八项研究中有四项发现患者的垂体体积与对照组相比有统计学上的显著增加。确定了一些不同的方法学问题，例如人群样本小、抑郁症的不同亚型以及患者和对照组的匹配不足。由于研究设计和数据的高度异质性，进行荟萃分析是无益的。结论是，HPA 轴的过度活跃是否会导致肾上腺和垂体增大仍不清楚，建议进行前瞻性研究，在连续的抑郁发作和缓解期间进行扫描。
