Abstract

The hypothalamus-pituitary-adrenal (HPA) axis is the endocrine axis most involved in the response to stress. Studies in first episode psychosis have recently reported raised levels of the stress hormones, cortisol and ACTH, and an increased volume of the pituitary gland, the main organ involved in the stress response. These findings suggest that first episode psychosis could be characterized by a hyperactivity of the HPA axis. These endocrine abnormalities could have important metabolic consequences for these patients, since activation of the stress hormonal system has been associated with increased intra-abdominal fat and impaired glucose tolerance. Increases in visceral or intra-abdominal fat distribution appear to be consistently associated with developing hyperinsulinemia, insulin resistance, dyslipidemia. Compared with the general population, patients with schizophrenia appear to suffer from higher rates of obesity-related illnesses such as impaired glucose tolerance, insulin resistance, type II diabetes mellitus and cardiovascular disease. This paper will review the evidence about HPA axis hyperactivity and metabolic abnormalities, and their possible link in first-episode psychosis.

Keywords: Metabolic Abnormalities, hypothalamus-pituitary-adrenal (HPA), stress hormones, pituitary gland, schizophrenia, obesity, cardiovascular disease