[Gonadal function in young female affective illness associated with the menstrual cycle--in relation to the polycystic ovary syndrome].
The hypothalamo-pituitary-gonadal axis was studied in 10 young manic-depressive or psychotic women whose symptoms obviously fluctuated in association with the menstrual cycle. The common clinical features of these cases were (1) young female aged between 15 and 25, (2) the symptoms fluctuated obviously in association with the menstrual cycle, and (3) severe manic-depressive, or psychotic symptoms. While, in two cases, the depressive or psychotic phases had repeated many times for several years, the rest eight cases did not have a long psychiatric past history. The common hormonal features among these 10 cases were elevated basal LH (7 of 10 cases), decreased basal FSH (6 of 10), greater response of LH and normal response of FSH to LHRH (8 of 8), lack of or insufficient increase of progesterone in the luteal phase (7 of 8), and elevated serum testosterone (5 of 10), androstenedione (4 of 10) and DHEA-S (3 of 9). These abnormalities resemble those of polycystic ovary syndrome (PCOS). Five of the 10 cases showed mild hirsute signs such as mustache, acne, and/or well-developed musculo-skeletal system. An ultrasonographical study revealed polycystic changes in 7 of 10 cases. Ordinary psychotropic pharmacotherapy was not effective sufficiently and hormonal therapy was tried in these 10 cases. Clomiphene citrate was administered on Day 5-9 of the menstrual cycle at a daily dose of 50mg orally in 9 cases, and it was effective to prevent recurrence of manic episode in one case, and to improve manic-depressive or psychotic symptoms in 6 cases. In these 6 cases, the effects were commonly observed within 1 or 2 weeks subsequent to the administration being completed. Daily dexamethasone administration was effective in one case with high serum DHEA-S level in whom clomiphene citrate worsened the psychotic symptoms, and thyroid hormone was effective in one case. In comparison with the pathophysiology of PCOS, a possible relationship was suggested between psychiatric problems and the PCOS-like hormonal abnormalities in these cases.
Matsunaga
H
H
Department of Psychiatry, Osaka Prefectural Hospital.
Sarai
M
M
Taniguchi
N
N
Kagomoto
T
T
Inui
M
M
Kameda
H
H
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000503:physiopathology*