Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Denmark.
Psychoneuroendocrinology. 2013 Nov;38(11):2394-404. doi: 10.1016/j.psyneuen.2013.06.030. Epub 2013 Jul 25.
A larger pituitary size is thought to reflect a greater activation of the hypothalamic-pituitary-adrenal (HPA) axis, which may be related to an increase in the number and size of corticotroph cells. Some studies, but not all, indicate that pituitary volume increases before or at the onset of psychosis. There is a need for at critical appraisal of the literature on this topic accompanied by a meta-analytical evaluation of the data.
We included studies comparing the volume of the pituitary gland in healthy controls and patients with schizophrenia, first episode of psychosis (FEP), schizotypal disorder or ultra high-risk (UHR) subjects. We defined three groups of subjects for the analyses: healthy controls; UHR and schizotypal patients; and patients diagnosed with first episode of psychosis, schizophrenia or schizoaffective disorder.
Ten studies were included in the meta-analysis. We found a trend of a larger pituitary volume in both UHR subject who had transition to psychosis (p=0.05) and in FEP subjects (p=0.09) compared to healthy controls. There was no difference in pituitary volume between patients with schizophrenia combined with FEP versus healthy controls (p=0.52) or between UHR (with and without transition) and healthy controls (p=0.24). In a regression analysis, we demonstrated that the number of subjects receiving antipsychotics and pituitary volume were positively correlated. As previously reported in other samples, gender also had an impact on pituitary volume with females presenting with a larger mean volume.
Results from this meta-analysis suggest that the pituitary gland could be increasing before the onset of psychosis. Both gender and use of antipsychotics have a major impact on the pituitary volume.
人们认为较大的垂体大小反映了下丘脑-垂体-肾上腺（HPA）轴的更大激活，这可能与促皮质细胞的数量和大小增加有关。一些研究，但不是全部研究表明，垂体体积在精神病发作之前或同时增加。因此，有必要对该主题的文献进行批判性评估，并对数据进行荟萃分析评估。
我们纳入了比较健康对照组和精神分裂症、首发精神病（FEP）、精神分裂样障碍或超高危（UHR）患者垂体体积的研究。我们将研究对象分为三组进行分析：健康对照组；UHR 和精神分裂样患者；以及诊断为首发精神病、精神分裂症或分裂情感障碍的患者。
10 项研究纳入荟萃分析。我们发现，与健康对照组相比，有精神病发作风险的 UHR 受试者（p=0.05）和 FEP 受试者（p=0.09）的垂体体积均有增大的趋势。患有 FEP 的精神分裂症患者与健康对照组（p=0.52）或 UHR（有和无转变）与健康对照组（p=0.24）之间的垂体体积无差异。在回归分析中，我们证明接受抗精神病药物治疗的受试者数量与垂体体积呈正相关。与其他样本中之前报道的一样，性别也对垂体体积有影响，女性的平均体积较大。
本荟萃分析的结果表明，垂体可能在精神病发作之前就开始增大。性别和抗精神病药物的使用对垂体体积有重大影响。
