Adrenal failure complicating status asthmaticus in steroid-treated patients.

Though pathological studies have shown that administration of adrenal steroids can cause adrenocortical atrophy in experimental animals (Ingle, 1938 ; Winter et al., 1950 ; Rawls et al., 1954; Holub et al., 1959) and in man (Sprague et al., 1950, 1951 ; Salassa et al., 1953 ; Bennett, 1954 Stoner and Whiteley, 1954), biochemical studies have revealed that the adrenal glands are capable of responding satisfactorily to corticotrophin (A.C.T.H.) stimulation despite many years of steroid therapy (Fredell et al., 1955 ; Larzelere et al., 1957; Carreon et al., 1960; Andersson and Kjerulf, 1961 ; Robinson et al., 1962 ; Savage et al., 1962 ; Brinck-Johnsen et al., 1963; Treadwell et al., 1963). Even when a subnormal increase in plasma 17-hydroxysteroids (17-OHCS; cortisol) is found during an infusion of A.C.T.H., a significant increase has been recorded with more prolonged adrenal stimulation (Eik-Nes et al., 1955 ; Christy et al., 1956 ; Sandberg et al., 1957 Krusius and Oka, 1958 ; Landon et al., 1965). There do not appear to be any reports on adrenal function during attacks of status asthmaticus in patients receiving longterm steroid therapy. The present paper describes the plasma 17-OHCS response to the administration of A.C.T.H. in 17 such patients with status asthmaticus.