Measurement of Pituitary Volume and Hormonal Changes in Patients With Post-traumatic Stress Disorder
Condition: Posttraumatic Stress Disorder
MeSH terms: Pituitary Diseases; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Observational

Summary: 
      Approximately, post-traumatic stress disorder (PTSD) occurs in 8% of the adult population
      over time. Exposure to traumatic events increases the risk of poor physical health and often
      leads to disability. The biology of PTSD is continually being explored in order to help find
      better treatments for this debilitating disorder. In our study, we propose to further our
      understanding of PTSD. Prior research has found that patients with PTSD have changes in the
      stress hormone pathway. In this pathway, there is release of certain hormones from the
      pituitary gland in the brain that feed into the blood stream and tell the adrenal gland to
      produce stress hormones.

      The pituitary is a gland located at the base of the brain which controls the hormones in the
      body, including the stress hormones. Research in other psychiatric disorders has found
      changes in the pituitary volume along with changes in the hormones. This has not been
      investigated yet in PTSD. Therefore, we propose in our study to measure pituitary volume in
      people with PTSD and look at the changes in the stress hormone pathway. Moreover, we will
      investigate whether other hormones are affected by PTSD. In this way, we can further our
      understanding of the the biology of PTSD and help develop new therapies which can intervene
      through the hormonal system.
    

Detailed description: 
      Lifetime prevalence of post-traumatic stress disorder (PTSD) is estimated at 8%. Exposure to
      traumatic events increases the risk of poor physical health, and chronic PTSD often leads to
      disability. The pathophysiology of PTSD is continually being explored in order to help find
      better treatment modalities for this debilitating disorder. Proposed mechanisms for the
      altered stress axis in PTSD include changes at the level of the pituitary. Though the
      pituitary stress hormone axis has been explored, no work has been done to evaluate for
      changes in the pituitary volume in response to these changes in the stress axis in PTSD. We
      have designed a study which will assess for differences in pituitary volumes. We will compare
      volumes in patients with PTSD, non-PTSD subjects who have had a history of trauma, and
      healthy controls. We will test the HPA axis through the dexamethasone/CRH test, a
      standardized diagnostic test, and correlate the findings with changes in the pituitary
      volume. Moreover, we will assess for changes in other endocrine axes and proteins.

      We propose to further our understanding of PTSD by establishing a direct link between
      structure and function. By establishing these links in structure and function, novel
      therapies which can intervene through the endocrine system may prove to be of benefit in
      treating PTSD
    

Intervention name(s): MRI of the pituitary; DEX/CRH test
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients will undergo a T1 weighted MRI of the pituitary to measure pituitary volume; Subjects will have blood drawn for baseline ACTH, cortisol, and other hormones and then undergo a DEX/CRH test. Will then measure ACTH and cortisol on test.
Other intervention name(s): MRI; Pituitary; Dexamethasone; CRH
Intervention MeSH terms: Dexamethasone
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects will be recruited from psychiatric clinics at Cedars-Sinai and at the West Los
        Angeles VA Center
      
Biospecimen description: 
      Will be collecting blood to check for hormone levels
    
Keywords: PTSD; HPA axis; Pituitary volume