The effect of ACTH on periodic (cyclic) neutropenia.

By BERNARD H. CHAIKEN, CAPT., MC, USAR P ERIODIC (cyclic) neutropeisia is a chrotsic disorder of the blood, characterized by the regular recurrensce of neutrophilic gratsubocytopetsia, at approximately three week itstervals, with secondary constitutiotsal symptoms such as anorexia, malaise, atsd fever, and secotsdary insfectiotss such as stomatitis, pharytsgitis, folliculitis, lymphadetsitis, atsd piseumonitis. Depression of the neutrophilic series of the botse marrow has been demonstrated during the neutropenic periods.7 Betweets these periods, the neutrophils return to tsormal and the patietits etsjoy good health. The cases have occurred at all ages, though many have beets reported as starting ins itsfancy, and they have had a variable duratiots, from a few monsths to as long as thirty-four years.7 The latter case has beets most extetssively studied, atsd papers have been written successively by Leabe4 its 1910, Rutledge, et al.” in 1930, Thompsots’3 its 1934, atsd Reimatsts7 its 1949; the last paper reported that the patient died of ptseumotsia at age 34. Reimann’s review of this and the fifteens other cases reported through 1949 revealed a remarkable climsical similarity of the cases, with cyclic neutropensia at approximately three week itstervals, establishiisg this condition as a specific clinical etstity. He suggested that this cousditiots might be a variation of the larger group of periodic diseases, the etiology of which is unknowns. Its onsly onse of the sixteen cases7 was there atsy evidetsce of asthma or other allergic matsifestatiotis. Skits tests its these patietsts have beets nsegative, atsd atstihistaminic drugs have had tso effect.3 Splensectomy has caused some amelioration of the secotsdary cliisical effects, or a less strikitsg diminsution of the neutrophils, as reported in six cases,13’5’9’12 but the periodic iseutropenia continued with tso cures effected. Its two cases, there was no clinical or other effect following spletsectomy.6’ The spleets was rarely eusbarged ansd the adreisalin test was negative.7 It is doubtful that hypersplenism is a primary factor, although in some cases with splensomegaby secotsdary to other cotsditions such as lymphosarcoma,’2 secotidary hyperspletsism may aggravate the utsderlying process. The possibility of ats etsdocritse dysfutsctiots was first suggested by Minot who saw the case reported by Rutledge.” Although the patietst was a male, the resemblatsce of the periodicity of the iseutropenic periods to the mensstruab cycle of womets impressed him, atsd he suggested that an alterations of the endocrine system might be respotssibbe for the cyclic depression of the bone marrow. Sparse hair atsd high pitched voice were presetst., aisd the patiemst later developed diabetes