ACTH therapy will satisfactorily control acute systemic manifestations in Still's disease. In this particular type of patient, ACTH treatment is preferable to oral corticosteroids, because (a) growth can be maintained, and (b) once the acute symptoms are brought under control, ACTH can be withdrawn without difficulty. On the other hand, with ACTH the arthritis is more difficult to control, and here its role may well be as a temporary measure while other drugs, such as gold, can take effect.
If corticosteroid therapy cannot be withdrawn well before puberty, then conversion to ACTH should be seriously considered, in order to gain the advantage of the pubertal growth spurt.
ACTH dosage should aim to allow endogenous ACTH production to occur. This can be gauged by measuring the 9 a.m. resting plasma cortisol levels 48 hours after ACTH administration. Concurrent use of ACTH and corticosteroids fails to maintain function of the hypothalamic pituitary adrenal axis.
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