PROBLEMS IN THE MANAGEMENT OF ULCERATIVE COLITIS, WITH PARTICULAR REFERENCE TO ACTH AND THE ADRENAL STEROIDS

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Abstract
Six patients with ul-cerative colitis are described, illustrating the role of ACTH and the corticosteroids in therapy. Aqueous ACTH is the most potent of these hormonal substances. Hydrocortisone and prednisone often control symptoms effectively and are valuable in maintenance therapy. The optimal duration of steroid therapy in ulcerative colitis is difficult to predict; continuous prolonged treatment for months and years may be necessary. The untoward effects of adrenal hormone administration include Cush-ing-like changes, edema, hypertension, hypokalemic alkalosis and infection. Psychosis, while not common is a serious problem, neces- sitating reduction in dosage and cessation of hormonal therapy, sedation and, occasionally chlorpromazine. Disseminated infection is a less common complication, necessitating intensive antibiotic therapy. Cor-ticotropin and related compounds thus are useful adjuncts to the conventional treatment of ulcerative colitis. The use of these powerful agents may be complicated by serious adverse effects which can usually be prevented or treated effectively.