9-ALPHA-FLUOROHYDROCORTISONE ALONE AND COMBINED WITH HYDROCORTISONE IN THE MANAGEMENT OF CHRONIC ADRENAL INSUFFICIENCY

SINCE the advent of cortisone in 1949, replacement therapy in chronic adrenal insufficiency has reached a more optimal level than had heretofore been possible. Cortisone acetate has been used alone and in combination with sodium chloride, as well as with various preparations of desoxycorticosterone. Thorn and his associates (1) have had extensive experience in the use of cortisone and of desoxycorticosterone in pellet form or as the trimethyl ester. For maintenance therapy they recommend cortisone in a dosage of 15 to 30 mg. daily together with desoxycorticosterone trimethyl acetate, 25 mg. every three weeks. We have been able to maintain our Addisonian patients on an average of 37.5 mg. of cortisone daily by mouth (given in three doses), with the addition of 4 to 6 grams of enteric-coated sodium chloride (2). The use of cortisone combined with desoxycorticosterone has been necessary only in 2 totally adrenalectomized patients in whom our usual replacement regimen did not correct the postural hypotension.