ADRENAL HORMONE THERAPY IN VIRAL HEPATITIS. I. THE EFFECT OF ACTH IN THE ACUTE DISEASE

Abstract

Twenty patients with acute viral hepatitis were treated with ACTH in strict alternation with 20 similar control patients who received injns. of saline. Half of the patients were started on injns. in the 1st 10 days after onset of illness, half in the 2d 10 days. Results in these groups were further compared with a control group of 200 similar cases admitted prior to the study. 100 of these were admitted in the 1st 10 days of illness, 100 in the 2d 10 days of illness. ACTH therapy was associated with a prompt drop in serum bilirubin in 18 of the treated patients, as compared to control groups. The time taken for apparent clinical recovery, complete disappearance of jaundice and return of bromsulfalein retention to 10% or less was somewhat longer in patients started on ACTH early in disease than in the control groups, and was about 10 days shorter than the controls in patients started on ACTH later in the disease. Four clinical relapses, 3 with jaundice, occurred in 10 cases in which. ACTH therapy was started in the 1st 10 days of illness. No clinical relapse occurred in 10 patients treated with ACTH later in the disease, and none in the combined group of 220 control patients. Liver biopsy studies done in the 10 early cases at the beginning and end of ACTH therapy did not differ appreciably from 10 control patients similarly studied, except insofar as fat deposits in the cells were concerned. The physiologic effect of ACTH in the 20 treated cases was notable in 2 respects: (a) only 7 patients showed a good eosinophil response; (b) glycosuria occurred in 16 patients and fasting hyperglycemia in 7 patients.