Pituitary volumes in hypochondriac patients Murad Atmaca a, ⁎, Hanefi Yildirim b , Semih Sec a , Alperen Kayali b a Firat University School of Medicine Department of Psychiatry, Elazig, Turkey b Firat University School of Medicine Department of Radiology, Elazig, Turkey abstract article info Article history: Received 15 October 2009 Received in revised form 13 December 2009 Accepted 13 December 2009 Available online 16 December 2009 Keywords: Hypochondriasis MRI Pituitary Volumetric To date, no study has examined the pituitary volumes in patients with hypochondriasis. In the present study, we evaluated pituitary volumes in patients with hypochondriasis and healthy controls. Twenty individuals with hypochondriasis (ten males, ten females), aged 20 to 48 years, and healthy controls were included into the study. The pituitary volumes were obtained. Volumetric measurements were made with T1-weighted coronal MRI images, with 2.4-mm-thick slices, at 1.5 T, and were done blindly. Volumetric measurements did not demonstrate group differences in the brain measurements, i.e., whole brain volume, white, and gray matter volumes (P > 0.05). We found significantly smaller pituitary volumes of the whole group of hypochondriac patients compared to healthy controls (age and ICV as covariates). To conclude, the results from the current investigation suggest that hypochondriac patients had smaller pituitary volumes compared with healthy controls. This could be the keystone to a better understanding of the neurobiological basis of hypochondriasis. © 2009 Published by Elsevier Inc. 1. Introduction Hypochondriasis is characterized by preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. This preoccupation persists despite of appropriate medical evaluation and reassurance. The main features include seeking repeated physical examinations, diagnostic tests, and reassurance from medical professionals and seeking reassur- ance from friends and family about their physical symptoms and doing extensive research on the disease. There are obviously limited neurobiologic and neuroanatomical investigations that examine the biological genesis of hypochondriasis. In fact, when a question raises which brain regions can be involved in hypochondriasis, it is so difficult to answer. Minor attempts were performed to explain how these symptoms arise. So, the neural correlates associated with somatoform disorders including hypochondriasis remain largely unknown to clinicians and neuroscientists alike. However, in the puzzling task of identifying the exact mechanisms underlying its pathophysiology, one of the main current lines of research may be brain circuitry. Hypochondriasis is currently classified as a somatoform disorder in DSM-IV. However it has some important similarities with obsessive– compulsive disorder (OCD), which is an anxiety disorder. OCD and hypochondriasis share a number of features, including intrusive thoughts and repeated checking (Barsky, 1992). At last, the discussion raised the question that “is hypochondriasis an anxiety disorder?” because of the fact that in hypochondriasis the underlying cognition may be more in accordance with an anxiety disorder (Olatunji et al., 2009). The role of hypothalamic–pituitary–adrenal axis (HPA) in anxiety and fear is well established. Under stress, hypothalamic corticotropin-releasing hormone (CRH) production rises, stimulating the pituitary release of adrenocorticotropin hormone (ACTH). Conse- quently, cortisol secretion by the adrenal cortex increases. Moving from this point of view, we aimed to examine possible alterations in the pituitary anatomy in patients with hypochondriasis by means of quantitative MRI. To our knowledge, pituitary volumes in hypochon- driasis have not been examined to date. 2. Materials and methods 2.1. Subjects The study was carried out at the Firat University School of Medicine Department of Psychiatry (Elazig, Turkey). All patients and comparison subjects signed written informed consent agreements following detailed explanation of the study and procedure. The Local Ethics Committee approved the study. Twenty individuals with hypochondri- asis (ten males, ten females), aged 20 to 42 years, were included in the Progress in Neuro-Psychopharmacology & Biological Psychiatry 34 (2010) 344–347 Abbreviations: OCD, obsessive–compulsive disorder; HPA, hypothalamic–pituitary– adrenal axis; CRH, corticotropin-releasing hormone; ACTH, adrenocorticotropin hormone; SCID, Structured Clinical Interview for the DSM-IV; HDRS, Hamilton Depression Rating Scale; ANCOVA, analysis of covariance; ICV, intracranial volume; DST, dexamethasone suppression test; CSF, cerebrospinal fluid. ⁎ Corresponding author. Firat (Euphrates) Universitesi, Firat Tip Merkezi, Psikiyatri Anabilim Dali, 23119, Elazig, Turkey. Tel.: +90 424 233 3555x2965; fax: +90 424 238 8096. E-mail address: matmaca_p@yahoo.com (M. Atmaca). 0278-5846/$ – see front matter © 2009 Published by Elsevier Inc. doi:10.1016/j.pnpbp.2009.12.012 Contents lists available at ScienceDirect Progress in Neuro-Psychopharmacology & Biological Psychiatry journal homepage: www.elsevier.com/locate/pnp