Enhanced corticotropin response to corticotropin-releasing hormone as a predictor of mania in euthymic bipolar patients.
BACKGROUND
Dysregulation of corticotropin (ACTH) and cortisol response after corticotropin-releasing hormone (CRH) stimulation has been reported in bipolar patients. Most findings involve the pathophysiology of the depressive phase of the illness and its prediction. However, the possible predictive value of the CRH challenge test with respect to manic episodes remains unknown.


METHODS
The ACTH and free cortisol response to the injection of 100 microg of synthetic human CRH and plasma cortisol-binding globulin levels were measured in 42 lithium-treated patients suffering from Research Diagnostic Criteria bipolar I disorder in remission, and 21 age- and sex-matched normal controls. A 1-year follow-up was conducted to assess any possible relationship between outcome and the hormonal response.


RESULTS
Bipolar patients showed higher baseline and peak ACTH concentrations than control subjects. A higher area under ACTH concentration curve after CRH stimulation predicted manic/hypomanic relapse within 6 months by multiple regression analysis.


CONCLUSIONS
Bipolar patients in remission show mild abnormalities in ACTH levels before and after CRH stimulation. CRH challenge may be a potentially good predictor of manic or hypomanic relapse in remitted bipolar patients.
Vieta
E
E
Department of Psychiatry, Hospital Clinic, University of Barcelona, Spain.
Martínez-De-Osaba
M J
MJ
Colom
F
F
Martínez-Arán
A
A
Benabarre
A
A
Gastó
C
C
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001714:Bipolar Disorder / Q000097:blood / Q000175:diagnosis* / Q000523:psychology; D003346:Corticotropin-Releasing Hormone; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012016:Reference Values
D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone