Untoward Reactions of Cortisone and ACTH.

By reviewing recent literature the authors present an account of untoward effects which may occur during therapy with cortisone or corticotropin (ACTH). The discussions of these reactions give little insight into their mechanisms, and several misleading statements occur. The action of cortisone which leads to osteoporosis and spontaneous fractures is not the same action which makes it useful in preventing fibrous tissue formation in traumatized joints as stated in the introduction. While the negative calcium and phosphorus balance during cortisone therapy is described, its physiological basis and, hence, its rational treatment are ignored. To speak of the "direct action of cortisone on the heart..." is hardly justified when describing the return of heart size to normal in Addison's disease. No details are included in the chapter on treatment. The use of stimulating doses of corticotropin periodically in patients on long-term cortisone therapy to prevent adrenal atrophy is not mentioned. The