Adrenal Apoplexy Occurring During Corticotropin Therapy of Ulcerative Colitis

Corticotropin has recently been employed in the treatment of chronic ulcerative colitis with favorable results.¹We are reporting a case of ulcerative colitis treated unsuccessfully with corticotropin, death occurring after the development of a clinical picture of acute adrenal insufficiency. At autopsy the adrenals showed bilateral massive hemorrhages of the type associated with the Waterhouse-Friderichsen syndrome. REPORT OF A CASE The patient was a 51-year-old Scottish woman with a 14 year history of recurrent attacks of diarrhea, passage of blood and mucus, and frequent episodes of nausea and vomiting. The attacks occurred at about two week intervals and lasted for about two weeks. Supportive treatment and diet had been used until January, 1952, when postprandial pain and excessive gas developed in the right upper abdominal quadrant. At the same time, the colitis was intensified. Roentgenograms revealed poor function of the gallbladder, and in February a cholecystectomy was performed. At