CONCURRENT OBSERVATIONS OF BEHAVIOR CHANGES AND OF ADRENOCORTICAL VARIATIONS IN A CYCLOTHYMIC PATIENT DURING A PERIOD OF 12 MONTHS

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Abstract
A study of adrenocortical function was carried out in a cyclothymic patient over a period of 12 months. The blood eosinophil levels and the levels of urinary 17-ketosteroids and gluco-corticoids were the indices chosen to measure changes in adrenocortical secretion. Uropepsin determinations are also reported. Gluco-corticoid excretion was abnormally low during the months of manic overactivity but rose to normal levels along with the patient''s clinical recovery. During the period of overactivity the gluco-corticoid values rose to normal levels in response to ACTH or hydro-cortisone on 3 occasions, and twice in association with psychologic situations which apparently constituted a specific challenge to the patient''s capacity for self-control. Throughout the entire period of study the urinary 17-ketosteroid excretion remained within normal limits. This was so even on those occasions when ACTH or hydrocortisone was given. There was no apparent correlation between the blood eosinophil levels and the clinical state or the urinary steroid levels. Uropepsin levels were slightly above the normal range during the period of over-activity and dropped abruptly to levels well within the normal range at the time of the patient''s recovery. The biochemical findings are interpreted in terms of an alteration in pituitary-adrenocortical function. The patient''s behavior, the nature of her fantasies, and her therapeutic relationship to the psychiatrist are described, and the results of psychologic tests are reported, including the Rorschach, Draw-a-Person and Thematic Apperception Tests. These tests were carried out during the depression which preceded her excitement, during her period of overactivity, and again since her recovery. The changes in adrenocortical function are related to her pattern of psycho-pathologic behavior.