BRITISH MEDICAL JOURNAL VOLUME 290 CLINICAL RESEARCH Selective increase in plasma luteinising hormone concentrations in drug free young men with mania L J WHALLEY, J E CHRISTIE, J BENNIE, H DICK, I M BLACKBURN, D BLACKWOOD, G SANCHEZ WATTS, G FINK Abstract The hypothalamic-pituitary-gonadal system was in- vestigated in drug free young men with either mania or acute schizophrenia and in age matched controls by measuring, at frequent intervals during a 17 hour "neuroendocrine day," plasma concentrations of luteinis- ing hormone (LH), follicle stimulating hormone, prolactin, testosterone, sex hormone binding globulin (SHBG), and cortisol. Plasma LH in mania was signifi- cantly increased compared with the control value at all time periods and increased in the morning and evening samples compared with values in the schizophre'nic patients. Plasma prolactin and cortisol concentrations were significantly greater in mania and schizophrenia compared with control values at several times during the day, but there were no significant between group differences in plasma testosterone or SHBG. These results show that (a) in young men with mania there is a major disturbance in the central mechanisms that control the release of LH, (b) the control of prolactin and cortisol secretion is abnormal in mania and acute schizophrenia, and (c) plasma LH concentrations may provide a useful hormonal diagnostic test for mania. MRC Brain Metabolism Unit, Department of Pharmacology, Edinburgh, and Thomas Clouston Clinic, Edinburgh L J WHALLEY, MD, MRCPSYCH, clinical scientist and consultant J E CHRISTIE, MPHIL, MRCPSYCH, clinical scientist and consultant J BENNIE, MIBIOL, senior research officer H DICK, MIST, technician I M BLACKBURN, PHD, clinical scientist and clinical psychologist D BLACKWOOD, PHD, MRCPSYCH, clinical scientist and senior registrar G SANCHEZ WATTS, technician G FINK, MD, DPHIL, director of MRC brain metabolism unit Correspondence and requests for reprints to: Professor George Fink, MRC Brain Metabolism Unit, University Department of Pharmacology, Edinburgh EH8 9JZ. Introduction The clinical distinction between affective psychoses and schizophrenia forms the basis of modern systems of classification in psychiatry. Comparisons between these psychoses have shown important differences in symptoms and outcome,' but no biological factor that distinguishes convincingly between schizophrenia and affective psychoses has been identified. We report a study of hypothalamic-pituitary-gonadal function in young men with either mania or schizophrenia and in healthy control subjects. Our aims were to identify hormonal factors that distinguished these psychoses from the normal state and to evaluate the potential contribution of the same hormonal factors to distinguish between schizophrenia and mania. Dysfunction of the hypothalamic-pituitary-gonadal axis in chronic schizophrenia has been reported,2 but this axis has not been investigated systematically in a comparative study of acute schizophrenia and the affective psychoses. Diminished plasma concentrations of luteinising hormone (LH) and follicle stimulat- ing hormone (FSH) have been found in chronic schizophrenia,2 and preliminary data suggest that plasma LH concentrations may be reduced in depression3 4 and increased in mania.5 These reports, together with observations that (a) changes in sexual interest occur commonly in manic depressive illness,6 (b) schizophrenia and mania are rare before puberty,7 (c) the risk of mania is higher in women than men,6 (d) the age at onset of schizophrenia is appreciably lower in men than women, I and (e) the fertility of patients with schizophrenia is substantially reduced even before the onset of their illness,9 suggest that study of gonadotrophin secretion might contribute to the distinction between schizophrenia and mania. In addition to LH and FSH we also measured plasma concentrations of prolactin, testosterone, sex hormone binding globulin (SHBG), and cortisol in blood samples collected according to a sampling schedule which permits assessment of both circadian and pulsatile patterns of hormone release. Subjects and methods Male patients aged 16-49 years routinely admitted to the Royal Edinburgh Hospital were selected for study if they had symptoms of mania or schizophrenia and had not taken any neuroleptic or 99 12 JANUARY 1985 on 16 June 2020 by guest. Protected by copyright. http://www.bmj.com/ Br Med J (Clin Res Ed): first published as 10.1136/bmj.290.6462.99 on 12 January 1985. Downloaded from