THE ROUTE OF ABSORPTION OF ORALLY ADMINISTERED CORTISONE IN A PATIENT WITH CHYLOTHORAX*

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Abstract
IT IS generally agreed that such hormonal steroids as testosterone, desoxycorticosterone, progesterone, estradiol and estrone are considerably less effective by mouth than when given parenterally. The diminished effectiveness of the oral route is assumed to result from increased hepatic inactivation of these steroid hormones consequent to portal absorption from the intestinal tract. In contrast, cortisone and hydrocortisone may be administered orally with relatively little loss of anti-inflammatory activity. Two explanations for the relative effectiveness of the latter two steroids may be suggested: cortisone and hydrocortisone may be absorbed through the lymphatics, thus avoiding direct circulation of the newly absorbed hormone through the liver, or these two steroids may be absorbed through the portal system, in which case it would be necessary to assume that approximately as much hormonal activity resists hepatic inactivation as that which is available following parenteral administration of the same dose. Although it has generally been assumed that corticosteroids administered orally are absorbed by the portal circulation, the evidence in support of this view, although suggestive, is not direct (1). Moreover, since it has been demonstrated in rats that cholesterol and epicholesterol are absorbed through the lymphatics (2), the possibility that corticosteroids are similarly absorbed cannot be excluded.