Periodic Catatonia Marked by Hypercortisolemia and Exacerbated by the Menses: A Case Report and Literature Review

Table 2

Biological variables during and between four catatonic episodes at the psychiatric state hospital (admission 18).

Episode	Trigger	Duration	Symptoms		Hypercortisolemia		Muscle Enzymes		↑ Platelets^2 (peak)
			Excitement	Stupor	↑ Cortisol^1; (peak)	↑ WBC^2; (peak)	↑ CK^3; (peak)	↑ LDH^3; (peak)
First	Menses	10 days; (194 to 203)	Yes	Yes	-	Yes; (12,300)	Yes; (1957)	No	Yes; (598,000)
Between first and second		147 days; (204 to 340)	No	No	-	-	-	-	-
Second	Menses & benzo stop	509 days; (341 to 849)	Yes	Yes	Intermittent; (28)	Persistent; (23,300)	Yes; (4920)	Yes; (424)	Yes; (888,000)
Between second and third		364 days; (850 to 1213)	No	No	No	Initially^4; (13,500)	No	No	Initially^5; (510,000)
Third	Menses & ECT delay	14 days; (1272 to 1283)	Yes	No	No	Yes; (24,200)	No	No	Initially^6; (474,000)
Between third and fourth		281 days; (1284 to 1562)	No	No	-	-	-	-	-
Fourth	Benzo stop	4 days; (1563 to 1567)	Yes	No	-	-	-	-	-

Benzo: benzodiazepines; CK: creatine kinase; ECT: electroconvulsive therapy; LDH: lactate dehydrogenase; WBC: white blood cell count.
¹Units mcg/dL
²Unit count in mm^3
3Units U/L
⁴WBC values were abnormal until 151 days after the end of the second catatonic episode.
⁵Platelet count was abnormal until 187 days after the end of the second catatonic episode.
⁶Platelet count was abnormal on day 5 of the third catatonic episode but after day 7 it became normal.