THIS STUDY is concerned with the effects of hydrocortisone (compound F) in patients with intractable primary sprue. Two forms of this steroid were used, the acetate and the free alcohol. While hydrocortisone acetate proved ineffective, the free alcohol of hydrocortisone, given orally, was found to be a valuable therapeutic agent in the management of these patients. The study represents an extension of our previous observations on the effects of corticotropin and cortisone acetate in sprue.1
SELECTION OF PATIENTSThe diagnosis of primary sprue was based on the typical symptoms and signs of this disorder, namely, diarrhea and steatorrhea, weakness, considerable weight loss, soreness of mouth and tongue, anemia, and polyavitaminosis ; the condition was associated in some instances with hypocalcemia, tetany, osteoporosis, and hypoproteinemia. In none of these patients was there evidence of pancreatic disease, and results of pancreatic enzyme studies, when performed, proved to be essentially normal. Roentgen studies failed to reveal evidence of organic disease in the gastrointestinal tract, as may be seen in secondary sprue.18 Many patients of this series showed at some time excellent or partial improvement on a sprue regimen consisting of high protein diet, with limitation of fats and polysaccharides, supplemented with adequate doses of liver extract, vitamin B12, and folie acid.2 In other patients no remission could be achieved; despite a seemingly satisfactory correction of the hematic status, diarrhea, steatorrhea,
