MANAGEMENT OF INTRACTABLE SPRUE WITH CORTISONE AND ADRENOCORTICOTROPIN (ACTH)

Abstract

Eight patients with the sprue syndrome were treated with 13 courses of cortisone and/or 8 courses of ACTH therapy. All but one patient proved resistant to conventional sprue therapy prior to hormonal admn. Admn. of cortisone and ACTH does not represent curative therapy, however, a clinical remission was observed in all cases, the extent varying from patient to patient. Disappearance of the diarrhea, an increased sense of well-being, improvement of appetite and gain in body wt., especially with prolonged treatment, were the important clinical manifestations. In some instances there was improvement of the serum albumin, the serum Ca, the roentgenologic findings in the small intestine and decrease of fat in the stools. Multiple courses of treatment with these hormones in the same patients resulted each time in clinical improvement, of essentially the same degree, in the same time interval, and on approx. the same dose. No instance of resistance to this form of therapy has thus far developed. 1-5 weeks after cessation of hormonal therapy, clinical relapses invariably occurred. It was therefore found advisable to maintain therapy-resistant sprue patients on minimal doses of cortisone or ACTH compatible with regression of their symptoms.