NASA NTRS2025
BACKGROUND Pituitary gland deformity and loss of pituitary height have been identified in astronauts postflight, hypothesized to be related to increased intracranial pressure or intracranial pressure pulsatility exposure from prolonged weightlessness. Microgravity-induced chronic headward fluid shift has been suggested as a root cause of intracranial compliance changes leading to altered intracranial pressure dynamics. Elevated intracranial pressure or pressure pulsatility is theorized to promote the development of an arachnoid diverticulum, which herniates into the pituitary fossa via a defect in the diaphragma sellae compressing the pituitary gland. We aimed to determine if chronic headward fluid induced by strict head-down tilt bed rest (HDTBR) can cause similar quantitative changes in pituitary gland height. METHODS Control group data from two 6-degree HDTBR studies were analyzed (SANS CM and AGBRESA). The AGBRESA study collected MRI data at Baseline, 14 days into HDTBR (HDTBR-14), 52 days into HDTBR (HDTBR-52), and three days into Recovery (R+ 3) and included eight healthy adults (2 women), age = 33 ± 8 years. The SANS CM collected MRI data at Baseline, 15 days into HDTBR (HDTBR-15), 29 days into HDTBR (HDTBR-29), and 12 days into Recovery (R+12) and included twelve healthy adults (4 women), age = 34 ± 9 years. Pituitary gland height was evaluated using a sagittal, 3D T1-MPRAGE sequence obtained on a dedicated 3T Siemens Biograph MRI scanner using a 32-channel head coil. Following the reconstruction of a true orthogonal sagittal plane of the pituitary gland using a 3D multiplanar reconstruction tool (Horosproject.org), the anterior pituitary mid-gland height at the pituitary stalk level was quantified according to the methodology described by Kramer et al. . A paired t-test was used to evaluate changes from the baseline measurements. FINDINGS The mean height of the pituitary gland at baseline was 6.5 ± 1.7 mm (AGBRESA) and 5.7 ± 1.6 mm (SANS CM). From baseline measurements, the SANS CM STUDY data showed a decrease in mean pituitary height of 0.3 mm (p=.011) at HDTBR-15, 0.5 mm at HDTBR-29 (p<.001) and 0.2 mm at R+12 (p=.02). From baseline measurements, the AGBRESA data showed a decrease in mean pituitary height of 0.3 mm (p=.06) at HDTBR-14, 0.6 mm at HDTBR-52 (p<.002) and 0.2 mm at R+3 (p=.13). CONCLUSION HDTBR results in progressive loss of pituitary height, which is most severe with the longest HDTBR exposure. Early pituitary height loss was the same at HDTBR-14 (AGBRESA) and HDTBR-15 (SANS CM). Residual pituitary height loss was the same at R+12 and R+3 but only significant in the latter (SANS CM). The degree of pituitary height loss at HDTBR-52 replicates the 0.6 mm height loss found in long-duration astronauts after approximately six months of microgravity exposure (p<.01, preflight mean height=5.9 mm). The hormonal effects of pituitary height loss are unknown in astronauts and HDTBR subjects and should be investigated in future studies. Future work will examine the individual variability in the loss of pituitary gland height and whether those changes are associated with other SANS findings, such as optic disc edema.