Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Department of Psychiatry, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan.
Brain Imaging Behav. 2024 Aug;18(4):701-709. doi: 10.1007/s11682-023-00834-x. Epub 2024 Feb 20.
In panic disorder (PD), functional disturbance of the hypothalamus-pituitary-adrenal (HPA) axis has been considered. However, in neuroimaging studies of PD, the hypothalamus and pituitary gland are poorly studied.We investigated the volume of PD patients' hypothalamus and pituitary gland, enrolling 38 PD patients and 38 healthy controls. Severity of PD was mild to moderate according to the Panic Disorder Severity Scale, and the illness duration was relatively short (median = 2.8 years). The hypothalamus' gray matter was automatically extracted and segmented, whereas the pituitary gland was manually traced. Regarding the hypothalamus, the paraventricular nucleus (PVH), which produces the corticotropin-releasing hormone, was of interest.The volumes of the pituitary and the bilateral anterior-superior hypothalamic subunits, where the PVH would be located, were compared by the multiple regression analyses controlling for age and intracranial content volume. To compensate for limitation in the abovementioned segmentation and analyses, the voxel-based morphometry with small volume correction (VBM-SVC) targeting the whole hypothalamus was also performed.The multiple regression analyses did not find significant effect of PD diagnosis on the volumes. However, in the VBM-SVC analysis, volume reduction of the PVH was suggested in PD even when patients who experienced PD for ≥ 3 years were excluded [peak coordinate (x, y, z = -2, 3, -8), FWE-corrected P = .022 (cluster-level) and 0.003 (peak-level), voxel size = 63]. Our results suggested structural alteration of the PVH in PD patients for the first time, indicating importance of the HPA-axis in PD pathology.
在惊恐障碍 (PD) 中，已经考虑到下丘脑-垂体-肾上腺 (HPA) 轴的功能障碍。然而，在 PD 的神经影像学研究中，下丘脑和垂体研究较少。我们研究了 PD 患者下丘脑和垂体的体积，纳入了 38 名 PD 患者和 38 名健康对照者。根据惊恐障碍严重程度量表，PD 严重程度为轻度至中度，且病程相对较短（中位数=2.8 年）。自动提取和分割下丘脑灰质，手动追踪垂体。关于下丘脑，产生促皮质素释放激素的室旁核 (PVH) 是研究的重点。通过多元回归分析，控制年龄和颅内内容积，比较垂体和双侧前上下丘脑亚区的体积，PVH 应该位于该区域。为了弥补上述分割和分析的局限性，还对整个下丘脑进行了基于体素的形态计量学（VBM-SVC）分析。多元回归分析未发现 PD 诊断对体积有显著影响。然而，在 VBM-SVC 分析中，即使排除了病程≥3 年的患者，也提示 PD 患者的 PVH 体积减少[峰坐标 (x，y，z = -2，3，-8)，FWE 校正 P=0.022(簇水平)和 0.003(峰水平)，体素大小=63]。我们的结果首次提示 PD 患者的 PVH 存在结构改变，表明 HPA 轴在 PD 病理中的重要性。
