Saunders Tyler S, Mondelli Valeria, Cullen Alexis E
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, UK.
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
Schizophr Res. 2019 Nov;213:23-31. doi: 10.1016/j.schres.2018.12.026. Epub 2018 Dec 29.
Pituitary volume (PV) abnormalities, representing one of several markers of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, have been observed in psychosis, with variable patterns across illness stages. Typically, enlargements characterise first-episode patients, with reductions observed in those with chronic illness relative to healthy controls. Findings in high-risk populations have been inconsistent, highlighting the need for an updated review of the evidence.
We searched PubMed, PsycINFO, and EMBASE for studies examining PV in high-risk [clinical high-risk (CHR), family history of psychosis (FHx), schizotypal personality disorder (SPD), and psychotic-experiences (PEs)] and healthy individuals. Random effects models were used to examine group differences in PV (Hedges g) with stratified analyses and meta-regression employed to investigate the effect of high-risk category, transition status, age, sex, and antipsychotic medication.
Ten studies, yielding 11 effect sizes, were eligible for inclusion. Overall, high-risk individuals had significantly larger PV relative to healthy controls (g = 0.16 [95% CI: 0.01 to 0.32] p = 0.04), despite showing a reduction in whole brain volume (g = -0.17, [95% CI. -0.30 to -0.03] p = 0.020). Individual sub-group analyses for CHR and FHx groups showed no significant differences relative to controls; however, larger PV increases characterised those who later transitioned to psychosis (g = 0.55, [95% CI. 0.06 to 1.04] p = 0.028). Larger effect sizes were positively associated with the proportion of high-risk individuals receiving antipsychotic medication.
PV enlargements characterise high-risk individuals and are more pronounced among those who later develop psychosis. We provide recommendations for future studies.
垂体体积（PV）异常是下丘脑 - 垂体 - 肾上腺（HPA）轴失调的几种标志物之一，在精神病患者中已被观察到，且在疾病各阶段呈现出不同模式。通常，首发患者的垂体体积表现为增大，而慢性病患者相对于健康对照者则出现垂体体积减小。高危人群中的研究结果并不一致，这凸显了对现有证据进行更新综述的必要性。
我们在PubMed、PsycINFO和EMBASE中检索了关于高危人群[临床高危（CHR）、精神病家族史（FHx）、分裂型人格障碍（SPD）和精神病性体验（PEs）]及健康个体垂体体积的研究。采用随机效应模型检验PV的组间差异（Hedges g），并运用分层分析和元回归研究高危类别、转归状态、年龄、性别及抗精神病药物的影响。
十项研究产生了11个效应量，符合纳入标准。总体而言，尽管高危个体的全脑体积减小（g = -0.17，[95%CI：-0.30至-0.03]，p = 0.020），但其垂体体积相对于健康对照者显著更大（g = 0.16 [95%CI：0.01至0.32]，p = 0.04）。对CHR组和FHx组的个体亚组分析显示，与对照组相比无显著差异；然而，后来发展为精神病的个体垂体体积增大更为明显（g = 0.55，[95%CI：0.06至1.04]，p = 0.028）。较大的效应量与接受抗精神病药物治疗的高危个体比例呈正相关。
垂体体积增大是高危个体的特征，且在后来发展为精神病的个体中更为明显。我们为未来研究提供了建议。
