ALTHOUGH much has been written about the untoward reactions which may follow the administration of corticotropin (ACTH) and cortisone, gastrointestinal complications seem to be rare. In Thayer's recent analysis,1 for example, of 66 patients who had been treated with these agents, only one complained of postprandial epigastric distress, which disappeared when corticotropin therapy was stopped. Nonetheless, a severe gastrointestinal disturbance may occasionally be caused by corticotropin or cortisone:
A middle-aged man had severe rheumatoid arthritis which prevented him from carrying on his work. Cortisone was given in full doses in the hope of relieving his pain. He had never had any stomach trouble before but, while receiving cortisone, soon had epigastric distress followed by a large hematemesis. There was high gastric acidity (histamine), and the roentgenogram showed a typical ulcer on the lesser curvature with a crater nearly 1 cm. deep. Cortisone administration was promptly discontinued, the epigastric distress subsided,