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Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study
Abstract
Subjects at their first psychotic episode show an enlarged volume of the pituitary gland, but whether this is due to hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, or to stimulation of the prolactin-secreting cells by antipsychotic treatment, is unclear. We measured pituitary volume, using 1.5-mm, coronal, 1.5 T, high-resolution MRI images, in 78 patients at the first psychotic episode and 78 age- and gender-matched healthy controls. In all, 18 patients were antipsychotic-free (12 of these were antipsychotic-naïve), 26 were receiving atypical antipsychotics, and 33 were receiving typical antipsychotics. As hypothesized, patients had a larger pituitary volume than controls (+22%, p< 0.001). When divided by antipsychotic treatment, and compared to controls, the pituitary volume was 15% larger in antipsychotic-free patients (p=0.028), 17% larger in patients receiving atypicals (p=0.01), and 30% larger in patients receiving typicals (p<0.001). Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together (+11%, p=0.08). When divided by diagnosis, and compared to controls, the pituitary volume was 24% larger in patients with schizophrenia/schizophreniform disorder (n=40, p<0.001), 19% larger in depressed patients (n=13, p=0.022), 16% larger in bipolar patients (n=16, p=0.037), and 12% larger in those with other psychoses (n=9, p=0.2). In conclusion, the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presence of antipsychotic treatment, and this could be due to activation of the HPA axis. Typical antipsychotics exert an additional enlarging effect on pituitary volume, likely to be related to activation of prolactin-secreting cells. This activation of the hormonal stress response could participate to the important metabolic abnormalities observed in patients with psychosis.
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“Pituitary volume changes have been reported in MDD with both increased (46, 47), reduced or not change in volume reported (48–50).”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [47]
In the citing paper
“The normal, dynamic development of the pituitary appears to be altered, with increased size prior to psychosis onset, and reduced size in chronic psychotic conditions, compared with normal groups [50-53] , although not all studies have reported this [54] .”
From The traumagenic neurodevelopmental model of psychosis revisited (2014) · cites this paper as [52]
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Metadata
- Authors
- Pariante, C. M., Dazzan, P., Danese, A., Morgan, K. D., Brudaglio, F., Morgan, C., Fearon, P., Orr, K., Hutchinson, G., Pantelis, C., Velakoulis, D., Jones, P. B., Leff, J., & Murray, R. M.
- Affiliations
- King's College London (GB)
- Sir Charles Gairdner Hospital (AU)
- University of the West Indies (TT)
- The Royal Melbourne Hospital (AU)
- University of Cambridge (GB)
- Corresponding author
- Pariante, Carmine M
- ORCID
- Venue
- Neuropsychopharmacology
- Published
- 2005-06-01
- Volume
- 30
- Issue
- 10
- Pages
- 1923-1931
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- OpenAlex
- W1978625524
- Cited by
- 152
- References
- 66
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2020: 2 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 14 · 2014: 10 · 2013: 13 · 2012: 4
- FWCI
- 7.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Medical Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- pituitary volume, first-episode psychosis, antipsychotic drugs, typical antipsychotics, atypical antipsychotics, hypothalamic-pituitary-adrenal axis, HPA axis hyperactivity, schizophrenia, bipolar disorder, depression
- MeSH terms
- Adolescent, Adult, Aged, Analysis of Variance, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Gland, Psychotic Disorders, Time Factors, Antipsychotic Agents, Case-Control Studies
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