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C. Lewis Ravaris, MD, PhD; Michael J. Sateia, MD; Kenneth W. Beroza, MD; Douglas L. Noordsy, MD
Department of Psychiatry

Truls Brinck-Johnsen, PhD
Department of Pathology Dartmouth Medical School Hanover, NH 03756

Arch Gen Psychiatry. 1988;45(10):966-967.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Depressed patients often but not invariably demonstrate a significant elevation in plasma cortisol concentration and a greatly augmented secretion of cortisol in the urine.^1,2 The extent to which hypercortisolemia is a primary or secondary manifestation of the psychopathology is under investigation.³

We had the unique opportunity to study a relationship between the level of plasma and urinary cortisol and the severity of the mood disorder in a depressed, 38-year-old woman who had undergone hypophysectomy. We administered ketoconazole, a broadspectrum antifungal agent that is a potent, rapidly acting, reversible inhibitor of cortisol-synthesizing 11-β-hydroxylase, a P-450-dependent enzyme. We did this during a recent hospitalization of the patient and noted a prompt reduction in cortisol production, with an equally prompt improvement in the patient's depressive illness. We present briefly the salient features of her diagnostic evaluation and inpatient treatment.

Report of a Case.—

The patient reported a long-standing . . . [Full Text PDF of this Article]

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