The effect of prolonged corticotropin therapy for rheumatic fever on the exchangeable sodium content and body weight.

Setial measurements of the bo(ly weight and the exchangeable sodium content were made in young pjatieIlts with acute lheumatic fever who weie being tieated with laige (loses of corticotropin. All lut one subject developed the clinical signs of hyperadrenalism. Eight of the 11 subjects showed at least a 20 per cent increase in body weight which could not be explained on the basis of the changes in exchangeable sodium content. This change in body composition is thought to be due primariily to an increase in total body fat. TILE prolonged administration of cor-ticotropin (ACTH) in therapeutic doses is known to produce the physical signs of hyperadrenalism.1 The increase in body weight resulting from such administration has usually been attributed in large measure to retention and redistribution of sodium and water. This explanation appears to be reasonable inl adults, since a decrease in body weight and rapid excretion of sodium often follows the administration of a diuretic agent or the discontinuance of corticotropin.A The "moon facies"' and the "buffalo hump" observed clinically, however, suggest a more profound change in body composition. To date few studies on the effects of ACTH on fat metabolism have been reported.4' In the course of a study on the immuino-physiology of rheumatic fever, it became apparent that rheumatic children and adolescents who gained weight while being treated with ACTH did not respond with diuresis when mercurial diuretics were given. The purpose of the present report is to demonstrate the marked discrepancy between the variations in the exchangeable sodium content of the body and the changes in the body weight during prolonged treatment of rheumatic fever with long-acting corticotropin (Acthar gel). MATERIAL AND METHODS Subjects. Eleven subjects, five females and six males, with the diagnosis of acute rheumatic fever were studied. Their ages ranged from 8 to 18 years, and seven patients were under 12 years of age. All subjects showed unequivocal clinical symptoms and signs of acute rheumatic activity as judged by the diagnostic criteria of Jones.6 The general plan of therapy was to administer daily a single intramuscular injection of Acthar gel in a dosage of 1 to 2.5 units per lb. (2.0 to 5.7 units per Kg.) of initial body weight and to maintain this dosage until the clinical and laboratory evi-dences of rheumatic activity had subsided. The dosage of corticotropin was then gradually reduced, unless signs of rheumatic activity recuried, in which case …