Adrenocorticotropic Hormone and Adrenal Steroids in the Management of Infectious Diseases

IN their initial reports upon the effects of corticotropin and cortisone in patients having rheumatoid arthritis or rheumatic fever, Hench and his as-sociates lf 2 emphasized two manifestations: inflammation of the tissues was subdued, and the patients experienced a remarkable sense of well-being. Soon thereafter, extensive observations were made by others 3 '4 '5 in human subjects having a variety of infections, and in experimentally infected ani-mals. It was demonstrated in patients with pneumococcal pneumonia that the administration of ACTH caused a crisis and striking improvement, al-though pneumococci persisted in the tissues for many days.6 On the other hand, it was also shown in many species of animals infected with different types of microorganisms that administered hormones would rapidly convert a mild infection into a fulminating and lethal disease. Likewise in man, the use of steroids was complicated by the appearance of infection, including the activation of latent tuberculosis. These early observations introduced a fortunate note of caution into the indiscriminate application of these agents