Effect of adrenocorticotrophic hormone (ACTH) on rheumatoid arthritis

The opportunity to observe the effect of administration of pituitary adrenocorticotrophic hormone (ACTH) and 11-dehydro-17-hydroxycorticosterone (cortisone) on the moderately active rheumatoid arthritis of a patient with panhypopituitarism was presented us. The clinical features (1, 2) of hypopituitarism are in essence those of hypo-function of the so-called "target" organs of the pituitary; the adrenal cortex, thyroid, and gonads. Sheehan and Summers (1) report "rheumatism of joints particularly of the knees" in 13 of 93 cases of panhypopituitarism, but elucidate no further on this clinical feature. The physiologic effects of ACTH and cortisone are well knonn (3,4), and the dramatic response of patients with rheumatoid arthritis to these agents has been amply recorded (3,5,6 would become apparent after ACTH administration.3. The response to cortisone.Case Report: LER, a 46 year old white woman, was first seen in the out-patient clinic at University Hospitals in 1945, complaining of intermittent attacks of swelling and tenderness of the shoulders, wrists, fingers, knees, and ankles. Recent attacks were associated with fever, anorexia, and weight loss. A vague history of increased heat tolerance was obtained. The husband described episodes that suggested hypoglycemia which had occurred intermittently during the preceding seven years. Menstrual and obstetrical history revealed that the only pregnancy, 27 years previously, had terminated with a prolonged labor, associated with excessive blood loss. Lactation was minimal, and ceased entirely after seven days. Menstrual function was not present after the pregnancy. Examination showed an asthenic, poorly nourished woman with dry skin. There was diminution of axillary and pubic hair. Blood presEure was 100/70 mm. Hg. Minimal joint signs were evident. Basal metabolic rates were -22%o and -27%. Erythrocyte sedimentation rate was 86 mm./hour (Westergren). Clinical diagnoses of hypothyroidism and rheumatoid arthritis were made. The patient was discharged on thyroid substance 0.1 gm. daily.There were four subsequent clinic visits, the final one being in August, 1946. Thyroid substance had been used only sporadically. On each occasion the patient complained of tachycardia. Little clhange was observed in the general appearance. The erythrocyte sedimentation rate remained elevated. On one occasion, a typical rheumatoid lesion of a metacarpal-phalyngeal joint was noted.She was admitted to the medical service in January, 1949. During the previous 30 months she had experienced progressive asthenia and increasing periods of sleep. Her only medication had been 30 mg. of thyroid substance daily. In recent months progressive swelling and tenderness in the right knee and left ankle had been observed. Examination showed a very torpid and listless woman whose weight was 106 pounds. The skin had no increased pigmentation and was smooth and dry. Axillary and pubic hair were sparse. The breasts were atrophic. The heart was small. Blood pressure was 70/50. Pelvic examination revealed an atr...

Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Observations During Acth and Cortisone Administration to a Patient With Longstanding Panhypo-Pituitarism and Rheumatoid Arthritis 1

Schrock¹,

Sheets²,

Bean³

1951

“…Insomnia has been observed before (1). The behavior of the furuncle in this patient recalls the profound disturbance in the formation of granulation tissue reported by Ragan and his associates (5,6), and raises serious questions concerning the safety of cortisone when administered to surgical patients or to those with infectious disease.…”

Section: Discussionsupporting

confidence: 60%

“…The minor subjective effects noted in this patient and the absence of significant mental or electroencephalographic changes suggest at least quantitative differences from the response that has been produced by the adrenocorticotropic hormone (4,5). Insomnia has been observed before (1).…”

Section: Discussionmentioning

confidence: 59%

Cortisone in Hypertensive Vascular Disease 1

Perera¹,

Fleming²,

Pines³

et al. 1950

Previous observations have indicated that the administration of cortisone may be associated with a decline in blood pressure in patients with uncomplicated hypertensive vascular disease (1). As the changes in arterial tension were comparatively small in these short-term studies, and usually took place immediately after the steroid had been discontinued, it seemed desirable to record the effects of increased dosage given for a longer period of time.CASE REPORT M. J., a 37-year-old Negro housewife, was admitted to the metabolism ward of the Presbyterian Hospital because of occasional headaches of moderate intensity, palpitations and hypertension known for five years. There was neither past nor present evidence of cardiac pain, congestive failure, renal, cerebral or obvious endocrine disease. Physical examination was not remarkable except for a blood pressure of 210/128 and slight arteriolar narrowing and arteriovenous compression on funduscopic examination.The patient was afebrile throughout the period of observation. Complete blood count, circulation time and venous pressure were within normal limits. Popliteal arterial pressures were not reduced. X-ray of the heart disclosed no hypertrophy and the electrocardiogram showed no significant abnormalities. Repeated urinalyses were negative; the urine concentrated to a specific gravity of 1.022; the phenolsulfonphthalein excretion was 80 per cent in two hours; and an intravenous pyelogram was normal. A benzodioxane test did not suggest the presence of a pheochromocytoma (2). METHODSThe patient was kept in bed until after blood studies and blood pressure measurements were made, and ambulatory activity was standardized at a constant level during the rest of the day. She was weighed daily before breakfast on the same scales. Distilled water was supplied for drinking. "Resting" blood pressures were measured each morning in the same arm by the same observer, 1 This investigation was supported (in part) by research grants from the National Heart Institute, U.S.-P.H.S., and was aided through the generosity of the Albert and Mary Lasker Foundation and the Albert H. and Jessie D. Wiggin Foundation.with the subject quiet and relaxed in bed, the head of which was raised to a 30-degree angle. At least seven readings were taken at half-minute intervals and the lowest systolic and lowest diastolic values recorded.Throughout the study the patient was given a constant diet and fluid intake: identical salt-poor daily menus (2,060 calories, including 62 gms. of protein and 268 gms. of carbohydrate), dietary sodium chloride and added salt administered in constant amounts in weighed salt shakers (totalling by direct analysis 75.7 milliequivalents per 24 hours), and a daily fluid intake of 1,770 cc. Chemical and laboratory determinations were undertaken by methods previously described (1). The cardiac output was calculated from ballistocardiographic tracings, taken serially throughout the study.2In order to secure an adequate baseline, preliminary observations were carried out for 34 days...

“…The continued use of these agents in man is associated with a loss of delayed hypersensitivity on skin testing (10) as well as decrease in immunoglobulin (Ig)l (11)(12)(13) by venapuncture from healthy human volunteers whose ages ranged from 26-to 36-yr old. Methylprednisolone, 48.5 mg, (equivalent to 60 mg prednisone, kindly supplied by Upjohn Company, Kalamazoo, Mich.) was dissolved in reconstituting solution and then given i.v.…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoids Administered In Vivo Inhibit Human Suppressor T Lymphocyte Function and Diminish B Lymphocyte Responsiveness in In Vitro Immunoglobulin Synthesis

Saxon¹,

Stevens²,

Ramer³

et al. 1978

155

A B S T R A C T The effects of corticosteroid given in vivo on human lymphocyte subpopulation function were investigated using an in vitro system of pokeweek mitogen-stimulated immunoglobulin production. Peripheral blood lymphocytes were obtained from normal volunteers before and 4 h after the intravenous administration of methylprednisolone. Unfractioned peripheral blood lymphocytes showed a consistent decrease (mean -50%) in immunoglobulin and total protein synthesis after steroid administration. Utilizing separated thymus-derived (T) and bone marrow-derived (B)