Skip to main content Accessibility help
×
Home

Contents:

Information:

  • Access
  • Cited by 1

Actions:

      • Send article to Kindle

        To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Pituitary in psychosis
        Available formats
        ×

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Pituitary in psychosis
        Available formats
        ×

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Pituitary in psychosis
        Available formats
        ×
Export citation

Pariante et al (2004) conclude that patients with first-episode psychosis have a larger pituitary volume and those with chronic schizophrenia a smaller pituitary volume in comparison with the controls. However, there are a number of factors that limit this conclusion.

First, normal variation in pituitary volume: a large degree of variation is observed in the morphology of anterior and posterior pituitary in healthy individuals (Fujisawa et al, 1987). Moreover, the variations may occur in the same individual if the measurements are repeated after an interval (Brooks et al, 1989). Therefore, conclusions based on a single measurement may be unreliable and at least two or three measurements should have been performed for better accuracy.

Second, effect of gender and age: men tend to have smaller pituitaries, as mentioned by Pariante et al, and the pituitary size decreases with age (Brooks et al, 1989). In the study by Pariante et al the schizophrenia group contained a significantly larger number of men and significantly older people compared with the control group. These differences could be partially responsible for the smaller pituitary size observed in chronic schizophrenia.

Third, failure to demonstrate the hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis: the correlation between HPA axis and pituitary volume is purely speculative and Pariante et al did not discuss the negative studies on the subject. Katona & Roth (1985) reported an abnormal dexamethasone suppression response in only 33% of patients (10 out of 30) with schizo-affective depression.

Fourth, failure to measure the adrenal gland size: adrenal gland hypertrophy has been shown to correlate with hyperactivity of the HPA axis in depression (Nemeroff et al, 1992). Pariante et al did not measure the adrenal gland size, probably as the study was not pre-planned and magnetic resonance imaging data obtained for another study were utilised. Measurement of adrenal gland size would have added more weight to the study findings.

Another comment worth mentioning is that hyperactivity of the HPA axis does not point to a specific diagnosis and occurs in a large number of conditions associated with stress. Therefore, this finding alone has a limited role in diagnosis of a particular condition.

Brooks, B. S., el Gammal, T., Allison, J. D., et al (1989) Frequency and variation of the posterior pituitary bright signal on MR images. American Journal of Neuroradiology, 10, 943948.
Fujisawa, I., Asato, R., Nishimura, K., et al (1987) Anterior and posterior lobes of the pituitary gland: assessment by 1.5 T MR imaging. Journal of Computer Assisted Tomography, 11, 214220.
Katona, C. L. & Roth, M. (1985) The dexamethasone suppression test in schizo-affective depression. Journal of Affective Disorders, 8, 107112.
Nemeroff, C. B., Krishnan, K. R., Reed, D., et al (1992) Adrenal gland enlargement in major depression. A computed tomographic study Archives of General Psychiatry, 49, 384387.
Pariante, C. M., Vassilopoulou, K., Velakoulis, D., et al (2004) Pituitary volume in psychosis. British Journal of Psychiatry, 185, 510.