Transcript MR VOLUMETRY OF PITUITARY GLAND IN FIRST EPISODE OF

Abstract Number : IRIA - 1151
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Growing interest - pathological and anatomical basis
of psychiatric illness.
Brain imaging – revolutionised study of
psychiatric illnesses.
Endocrine abnormalities may underlie many mental
conditions.
Role of Hypothalamus – Pituitary – Adrenal axis
hyperactivity
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To find out pituitary volume in first episode of
psychopathology by MRI in comparison to the age
and sex matched controls.
Follow up MRI of psychiatric patients, to review
pituitary volume after 3 months
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Dec 2012 to Aug 14
50 cases with symptoms of psychiatric illness for
the first time and presenting within one month of
onset of illness
50 age and gender matched controls
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Case of any known structural or neurological
disease
Electroconvulsive therapy during 6 months before
scan
Any contraindication to MRI
Patients already on antipsychotic medication
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MRI of brain for Pituitary volume measurement
 Initial imaging (both cases and controls)
 Follow up MRI after 3 months (only cases)
Protocol
T1 weighted sequence
 TE - 4.4 ms
 TR -1180 ms
 Slice thickness - 0.9 mm
 Contiguous slices
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Anterior and posterior pituitary
gland traced in all saggital slices
separately
Volume of the Pituitary (in mm3) summing areas for all relevant
slices and multiply by 0.9
Sample size: 50 Cases +50 Controls
Clinical data collected
MRI brain and pituitary volume calculation
Follow up MRI of study group after 3 months
Correlation with final diagnosis
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Original data - means and standard deviations.
Analysis of Covariance (ANCOVA) - to compare
significance of differences between
 Pituitary Volumes in Controls and Cases at initial
MRI
 Between Pituitary volumes in Cases at initial MRI
and review MRI, i.e. after three months.
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Cases - 28 males and 22 females.
Mean age of cases - 36.3 years
Psychiatric diagnosis profile
ANCOVA ANALYSIS – COMPARISON OF TOTAL PITUITARY VOLUMES
Pariante et al (2004)
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Krishnan et al (1990)
71 % (Present study - 74%)  Depression – larger pituitary
volumes (concordant with
of First-episode group - had
present study)
Pituitary volumes larger than
control by 10 % (present
Roberto B Sassi et al (2001)
study - 15.4%)
• Reduced pituitary volume in
Women had larger Pituitary
bipolar disorder (larger in
than men in the group.
present study)
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Irrespective of the diagnosis, majority of the
cases presenting for the first time with a
psychiatric illness – Had significantly larger
pituitary glands (anterior pituitary)
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Enlarged pituitary gland – likely HPA axis
overactivity in initial phase
? Glucocorticoid resistance
? Stress induced
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First episode of psychiatric disorder - associated
with enlargement of the Pituitary.
May indicate activation of hormonal stress response
(HPA axis)
Prospective studies needed to clarify whether
measurements of the stress response can be used to
predict the development of psychosis.
1.
Pariante CM, Vassilopoulou K, Velakoulis D, et al. Pitui-tary volume in psychosis. Brit J Psychiat.
2004;185: 5–10
2.
Krishnan KR, Doraiswamy PM ,Lurie SN, et al. Pituitary size in depression. Journal of Clinical
Endocrinology and Metabolism. 1991;72: 256-259
3.
Sassi, RB, Nicoletti M, Brambilla P, et al. Decreased Pituitary volume in patients with bipolar
disorder. Biological Psychiatry 2001; 50:271 -280.
4.
Pariante CM. Pituitary volume in psychosis: First review of evidence. J
Psychopharmacol.2008;22(suppl):76-81
5.
Lurie SN, Doraiswamy PM, Husain MM, et al. In vivo assessment of Pituitary gland volume with magnetic
resonance imaging: the effect of age. Journal of Clinical Endocrinology and Metabolism 1990; 71: 505-508
6.
Takano K, Utsunomiya H, Ono H, Ohfu M, Okazaki M. Normal development of the Pituitary gland:
assessment with three-dimensional MR volumetry. AJNR Am J Neuroradiol. 1999; 20:312–315
7.
MacMaster FP, Leslie R, Rosenberg DR. Pituitary gland volume in adolescent and young adult bipolar and
unipolar depression. Bipolar Disorders 2008; 10: 101–104