A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia

doi:10.1016/0006-3223(90)90628-F

Biological Psychiatry

Volume 28, Issue 2, 15 July 1990, Pages 110-116

https://doi.org/10.1016/0006-3223(90)90628-F Get rights and content

Abstract

Magnetic resonance imaging (MRI) of the brain was used to examine the morphology and dimensions of the pituitary gland in 18 patients with eating disorders (8 anorectics and 10 bulimics), in comparison with 13 healthy volunteers. None of the 18 patients with anorexia or bulimia had any radiological evidence suggestive of pituitary macroadenoma. cyst, or empty sella. Measurements revealed that the anorectics and bulimics had smaller pituitary gland cross-sectional areas (p < 0.05) and smaller pituitary gland heights, compared with healthy controls. These preliminary findings in anorectics and bulimics are suggestive of pituitary atrophy secondary to nutritional or endocrine alterations, rather than a primary pituitary pathology.

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Cited by (53)

Pituitary gland shrinkage in bipolar disorder: The role of gender
2018, Comprehensive Psychiatry
Citation Excerpt :
Specifically, the results from a recent meta-analysis and systematic review suggested that the HPAA hyperactivity could be considered both a long-term trait and a state feature of BD, being more evident during manic phases, but also persisting during symptoms remission [8]. In this context, it has to be kept in mind that our group of BD patients were chronically ill and therefore it might be plausible that they had a long-term exposure to hypercortisolemia, which may have enhanced the negative feedback control over time and determined the atrophy in PG volumes, as also reported by other previous studies in both BD [18,19] and other psychiatric disorders [32,55]. This hypothesized long-term effect of hypercortisolemia towards the PG volume in BD may explain the contrasting results obtained by other authors who found increased PG volumes in first-episode-psychosis BD patients [14] as well as normal [19] or increased [13,17] PG size in children and adolescents with BD compared to HC.
Hyperactivity of the Hypothalamic-Pituitary-Adrenal Axis (HPAA) has been consistently reported in mood disorders. However, only few studies investigated the Pituitary gland (PG) in Bipolar Disorder (BD) and the results are so far contrasting. Therefore, the aim of this study is to explore the integrity of the PG as well as the role of gender and the impact of clinical measurements on this structure in a sample of BD patients compared to healthy controls (HC).
34 BD patients and 41 HC underwent a 1.5 T MRI scan. PG volumes were manually traced for all subjects. Psychiatric symptoms were assessed by means of the Brief Psychiatry Rating Scale, the Hamilton Depression Rating Scale and the Bech Rafaelsen Mania Rating Scale.
We found decreased PG volumes in BD patients compared to HC (F = 24.9, p < 0.001).
Interestingly, after dividing the sample by gender, a significant PG volume decrease was detected only in female BD patients compared to female HC (F = 9.1, p < 0.001), but not in male BD compared to male HC (F = −0.12, p = 0.074). No significant correlations were observed between PG volumes and clinical variables.
Our findings suggest that BD patients have decreased PG volumes, probably due to the long-term hyperactivity of the HPAA and to the consequent strengthening of the negative feedback control towards the PG volume itself. This alteration was particularly evident in females, suggesting a role of gender in affecting PG volumes in BD. Finally, the absence of significant correlations between PG volumes and clinical variables further supports that PG disruption is a trait feature of BD, being independent of symptoms severity and duration of treatment.
Gray matter decrease distribution in the early stages of Anorexia Nervosa restrictive type in adolescents
2011, Psychiatry Research - Neuroimaging
Citation Excerpt :
Some authors indicated a relationship between brain mass loss and severity of AN (Kohlmeyer et al., 1983; Golden et al., 1996; Katzman et al., 1996), a full reversibility of brain mass loss (Golden et al., 1996; Swayze et al., 1996; Chowdhury et al., 2003), and persistence of GM decrease (Katzman et al., 1997; Lambe et al., 1997). A few authors used magnetic resonance imaging (MRI) and manual volume measurement in AN patients demonstrating a significant volume reduction in the hypophysis (Doraiswamy et al., 1990) and the amygdala–hippocampus complex (Giordano et al., 2001). In recent years, the availability of the automated Voxel-Based Morphometry (VBM) technique has enabled us to make a more reliable global and regional evaluation of GM, WM and CSF volume and concentration alterations.
Few studies have used Voxel-Based Morphometry (VBM) to examine brain structure in Anorexia Nervosa patients. The purpose of the present study was to investigate a sample of Anorexia Nervosa restrictive type (AN-r) adolescent patients in the early stages of the illness, using VBM in order to characterize morphometric gray matter (GM) changes. Participants were 16 AN-r female patients (with no other psychiatric disorders) whose AN-r had been in progress for less than 12 months and 16 age-matched healthy female subjects. High-resolution T1-weighted magnetic resonance images were preprocessed according to the optimized VBM method, and statistically analyzed. The analyses revealed a significant global GM decrease in the AN-r patients; furthermore, a significant region-specific decrease in GM volume was found bilaterally in the middle cingulate cortex, the precuneus, and the inferior and superior parietal lobules. The significant early GM decrease in the aforementioned regions in AN-r adolescent patients suggests that there might be a region-specific GM vulnerability that could play a role in the pathophysiology of the disease. Given that these regions are also involved in the manipulation of mental images and the mental representation of the self, this might explain the presence of a distorted body image in these patients.
Pituitary volume in teenagers with first-presentation borderline personality disorder
2007, Psychiatry Research - Neuroimaging
This study used magnetic resonance imaging to examine pituitary gland volume (PGV) in teenage patients with a first presentation of borderline personality disorder (BPD). No difference in PGV was observed between healthy controls (n = 20) and the total BPD cohort (n = 20). However, within the BPD cohort, those exposed to childhood trauma (n = 9) tended to have smaller pituitaries (− 18%) than those with no history of childhood trauma (n = 10). These preliminary findings suggest that exposure to childhood trauma, rather than BPD, per se, might be associated with reduced PGV, possibly reflecting hypothalamic–pituitary–adrenal axis dysfunction.
Development and sexual dimorphism of the pituitary gland
2007, Life Sciences
The pituitary gland plays a central role in sexual development and brain function. Therefore, we examined the effect of age and gender on pituitary volume in a large sample of healthy children and adults. Volumetric magnetic resonance imaging (MRI) was conducted in one hundred and fifty four (77 males and 77 females) healthy participants. Males were between the ages of 7 to 35 years (16.91 ± 5.89 years) and females were 7 to 35 years of age (16.75 ± 5.75 years). Subjects were divided into subgroups of age (7 to 9, 10 to 13, 14 to 17, 18 to 21, 22 and older) and sex (male/female). Pituitary gland volume differed between sexes when comparing the age groups (F = 3.55, df = 2, 143, p = 0.03). Females demonstrated larger pituitary glands than males in the age 14 to 17 year old groups (p = 0.04). Young (19 years and under) and old (20 years and older) females demonstrated a correlation between pituitary volume and age. Males did not show this relationship. These findings provide additional evidence for gender differences in the normative anatomy of the pituitary and may have relevance for the study of various childhood onset neuropsychiatric disorders in which pituitary dysfunction has been implicated.
Pituitary volume in neuroleptic-naïve schizophrenia: A structural MRI study
2007, Schizophrenia Research
Abnormalities in the hypothalamic–pituitary–adrenal axis (HPA) have been implicated in psychosis. To our knowledge, no prior study has measured pituitary volume in a neuroleptic-naïve schizophrenic population. Herein, we present data exploring the volumetric differences in a sample of antipsychotic-naïve patients with a DSM-IV diagnosis of schizophrenia versus appropriately matched healthy controls.
Pituitary volumes were measured in 51 patients with schizophrenia (36 males, 15 females, mean age ± S.D.: 25.2 ± 7.4 years) and 55 healthy controls (30 males, 25 females; mean age ± S.D.: 25.2 ± 6.6 years) Measurements were conducted on 1.5 mm thick T1-weighted coronal images from a 1.5T scanner by two trained raters. Patients with schizophrenia had significantly smaller pituitary volumes than healthy control subjects (mean volume ± S.D. = 0.58 ± 0.14 cm³ and 0.66 ± 0.17 cm³ respectively; ANCOVA (using intracranial volume, gender and age as covariates), F = 6.81, df = 1, 101; p = 0.01). These findings provide new evidence of a smaller pituitary volume in neuroleptic-naïve patients with schizophrenia. The observed alterations in pituitary volume are consistent with neuroendocrine studies that have reported abnormalities in the HPA axis in psychosis. Similar volume reductions have been seen in other neuropsychiatric populations and may cut across diagnostic boundaries.
Pituitary Volume in Treatment-Naïve Pediatric Major Depressive Disorder
2006, Biological Psychiatry
Citation Excerpt :
Validation of this method by a point-counting stereological approach on the basis of Cavalieri’s theorem of systematic sampling has been achieved, with both methods having documented validity and sensitivity (Keshavan et al 1995). Neuroanatomical boundaries of the pituitary gland were determined by reference to standard neuroanatomical atlases (Daniels et al 1987; Talairach and Tournoux 1988) with specific definitions adapted from previously published neuroimaging studies of the pituitary (Doraiswamy et al 1990, 1991a, 1991b; Krishnan et al 1991; MacMaster and Kusumakar 2004; MacMaster et al 2006; Sassi et al 2001; Thomas and DeBellis 2004; Tien et al 1992). The superior border of the pituitary was identified as the optic chiasm and infundibular recess of the third ventricle.
Prior pilot investigation identified a larger pituitary gland volume (PGV) in pediatric patients with major depressive disorder (MDD) compared with healthy pediatric control subjects that was most prominent in boys with MDD. In this independent sample, we focus on gender differences in pituitary volume in a larger sample of pediatric patients with MDD.
Volumetric magnetic resonance imaging studies were conducted in 35 psychotropic drug-naïve children (15 boys, 20 girls), ages 8–17 years, and 35 case-matched healthy control subjects.
The MDD boys had larger PGV (19%) compared with male control subjects. No significant diagnostic group differences in pituitary volume were observed in girls. Healthy boys had significantly smaller PGV (27%) than healthy girls, whereas MDD boys did not differ from girls with MDD. Nonfamilial (without a family history of mood disorder) boys with MDD had significantly larger PGV (35%) than male healthy control subjects and tended to have a larger PGV (27%) than familial (at least one first-degree relative with MDD) boys with MDD. Boys with familial MDD did not differ from control subjects.
These findings provide new evidence of increased pituitary volume in psychotropic-naïve pediatric patients with MDD that seems to be more prominent in male patients with nonfamilial MDD.

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A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia

Abstract

Radio Clin North Am

Am J Med

J Nutr

Diagnostic and Statistical Manual of Mental Disorders

The volume of the sella turcia in patients with anorexia nervosa

Eur Neurol

Frequency and variation of the posterior pituitary bright signal on MR images

AJNR

Posterior pituitary gland: Appearance on MR images in normal and pathologic states

Radiology

The volume of the sella turcica

Am J Roentgenol