Effects of Exogenous Adrenocorticotropic Hormone (Acth) Upon Pituitary Acth Concentration After Prolonged Cortisone Treatment and Stress*

Symptoms and metabolic abnormalities closely resembling those of hypoadrenalism have been reported following cessation of prolonged treatment with adrenal steroids (1-5). Sudden death following surgery has been reported in association with this syndrome and has been ascribed to fail- ure of the hypothalamic-pituitary-adrenal system to respond to stress (6-9). Since prolonged ad- ministration of corticosteroids produces adrenal atrophy in both man and laboratory animals (7, 10, 11), this failure has been attributed to adrenal insufficiency. Exogenous corticotropin (ACTH) will repair or maintain normal adrenal weight in the cortisone-treated animal (12). Consequently the addition of ACTH in various dosage sched- ules has been advocated for the purpose of main- taining or restoring normal adrenal responsiveness to stress The efficacy of such combined therapy is not firmly established.