Recent clinical observations and animal experiments1have shown that prolonged administration of cortisone produces adrenal atrophy. According to the adaptation syndrome of Selye,2adrenal atrophy in turn may lessen the body's ability to withstand trauma and stress. One might suspect that patients receiving cortisone would not normally withstand major surgery; yet every day patients are successfully undergoing surgery while regularly taking cortisone in both the preoperative and postoperative periods. We wish to present the record of a patient who, while receiving a prolonged course of cortisone therapy, underwent a major operation, cup arthroplasty of the hip, and died of immediate postoperative shock, in spite of normally adequate, aggressive antishock therapy. Postmortem examination revealed marked bilateral adrenal atrophy and other conditions consistent with shock. REPORT OF A CASE A 34-year-old man had had rheumatoid arthritis for a period of seven years. Almost every joint of his body was involved,