A REFRACTORY CASE OF IDIOPATHIC STEATORRHEA (NON-TROPICAL SPRUE), WITH OBSERVATIONS ON THE THERAPEUTIC EFFECTS OF SALT-POOR HUMAN ALBUMIN AND OF THE ADRENOCORTICOTROPIC HORMONE

Abstract

A case of idiopathic steatorrhea, refractory to conventional treatment, is reported. On 3 occasions, elevation of the serum albumin from subnormal to normal levels by the transfusion, or the use of pooled plasma or salt-poor human serum albumin, caused disappearance of diarrhea and return of appetite and strength. These remissions ended with serum albumin levels still within normal range. On 2 occasions, with symptoms present in spite of normal albumin level, plasma or salt-poor albumin failed to produce remission. These observations were interpreted as due to restoration of normal serum oncotic pressure, with consequent improvement in intestinal absorption. During a later relapse, ACTH (25 mg. intramusc. 4 times per day for 6 wks.) caused diarrhea to disappear, wt. to increase, and the motility of the small intestine, as indicated by X-ray, to improve markedly. No effect on absorption of glucose could be demonstrated. Relapse occurred shortly after reduction of the dosage of ACTH to an ineffective level.