RECOGNITION AND PREVENTION OF THE COMPLICATIONS OF
ACTH AND CORTISONE THERAPY
THOMAS F. FRAWLEY, M.D.
BOSTON

N THE THREE years which have elapsed since the pituitary adrenocortico­
tropic hormone and cortisone became available for general use, numerous
reports of their clinical effectiveness have appeared.*1 * * *In
S. general, all reports tend
to emphasize the dramatic beneficial effects of these hormones in acute and chronic
diseases, many of which have proved refractory to other forms of therapy.
Occasionally, with the changing levels of adrenal hormones which accompany ACTH
and cortisone administration, undesirable physiological effects are produced.
These may appear with the large doses of hormone required to control a pathological
process, but more often they are due to doses of hormone which are larger than
necessary. Fortunately, in most instances these untoward effects regress on dis­
continuance of treatment; but even more important is the fact that the majority
may be prevented by specific measures and by more careful selection of patients
who are to receive ACTH, cortisone or similar hormonal therapy.
It is the purpose of this paper to review some of the complications of ACTH and
cortisone therapy and to discuss their prevention and treatment. As an initial
approach to the understanding of these complications, the physiological effects of the
adrenal steroids will be considered briefly.

I

PHYSIOLOGICAL EFFECTS

Adrenocorticotropic hormone (ACTH) is a naturally occurring hormone
which is obtained from the pituitary glands of domestic animals. This hormone
induces its physiological effects only through stimulation of the adrenal cortex to
Read in part at a meeting sponsored by the Occupational Medical Clinic at the Massachu­
setts General Hospital, Dec. 13, 1950.
From the Medical Clinic, Peter Bent Brigham Hospital, and the Department of Medicine,
Harvard Medical School. Dr. Erawley was research fellow in medicine at Harvard Medical
School; and assistant in medicine at Peter Bent Brigham Hospital at the time of writing. At
the time of publication he is assistant professor of medicine, Albany Medical College, and
director of the department of endocrinology and metabolism, Albany Hospital.
1. (a) Hench, P. S.; Kendall, E. C.; Slocumb, C. H., and Polley, H. F.; Effect of Hor­
mone of Adrenal Cortex (17-Hydroxy-ll-Dehydrocorticosterone, Compound E) and of Pitui­
tary Adrenocorticotropic Hormone on Rheumatoid Arthritis, Proc. Staff Meet., Mayo Clin.
24:181-197, 1949. (b) Thorn, G. W.; Bayles, T. B,; Massell, B. F.; Forsham, P. H.; Hill,
S. R., Jr.; Smith, S., Ill, and Warren, J. E.: :Medical Progress: Studies on the Relation of
Pituitary-Adrenal Function to Rheumatic Disease, New England J. Med. 241:529-537, 1949.
(c) Thorn, G. W.; Forsham, P. H.; Frawley, T. F.; Hill, S. R., Jr.; Roche, M.; Staehelin, D.,
arid Wilson, D. h.: Medical Progress: The Clinical Usefulness of ACTH and Cortisone, ibid.
242:783-793, 824-834, 865-872, 1950. (d) Proceedings of the First Clinical ACTH Conference,
edited by J. R. Mote, Philadelphia, The Blakiston Company, 1950.

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