The recent availability of cortisone has made possible great improvement in the treatment of chronic adrenal cortical insufficiency. The effect of its parenteral administration in patients with Addison's disease has been well documented,1 but there is less information on the adequacy of oral therapy. Further data on the latter method of treatment are desirable in regard to both clinical and metabolic responses. Oral therapy, if proved effective, would permit the patient to adjust his dose easily, in accordance with the severity of symptoms, and, at the same time, would obviate the inconvenience of injections.The six patients whose case histories provide the material for this report were studied with special reference to their responses to oral administration of cortisone.Four patients had uncomplicated Addison's disease; one had Addison's disease and diabetes mellitus; and another had symptoms of hypoadrenocorticism, secondary to removal of a chromophobe adenoma of the pituitary. The first four patients were followed in the metabolic wards of the hospital, and the other two were from private practice.Gains in strength and weight and a sense of well-being were considered the most important evidence of a favor¬ able clinical response. Metabolic observations included ( 1 ) alteration in carbohydrate metabolism, as shown by changes in glucose tolerance curves,2 (2) changes in the urinary excretion of 17-ketosteroids (modification of Pincus' method3) and 11-oxysteroids,4 (3) changes in serum electrolytes, and (4) changes in response to in¬ gestion of water, as demonstrated by Robinson-Power-Kepler water test.5 Treatment with desoxycorticosterone acetate, started previous to this study, was continued in all cases. For the patient with diabetes mellitus and Addison's disease and for the patient with secondary adrenal cortical insuf¬ ficiency, oral use of cortisone was substituted for daily injections of 0.5 to 1 cc. of lipo-adrenal cortex.
REPORT OF CASESCase 1.-A. B., a 29-year-old white man, was well until June, 1945, when, while serving in the European theater of war, he ex¬ perienced progressive weakness, weight loss, and hypotension. A diagnosis of Addison's disease was made. Treatment consisted of desoxycorticosterone acetate implants, 500 to 850 mg. at 15 to 18 month intervals. After onset of the disease, progressive pigmentation of the skin and occasional spells of weakness and dizziness occurred. When the implants were exhausted, the pa¬ tient became anorexic, weak, and drowsy and had an elevated serum potassium level, depressed serum sodium and chloride levels, hypotension, and hypoglycemia. He responded well to im¬ plantation of desoxycorticosterone acetate and was able to work as an accountant for three to four hours daily without excessive fatigue.Examination in February, 1951, revealed an alert, well-nour¬ ished, well-developed man with deeply pigmented skin. Brownish pigmentation was present on mucous membranes, in skin creases,
