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To the Editor:
—The editorial of May 12, 1951, on the effect of cortisone and ACTH on the erythrocyte sedimentation rate placed undue emphasis on but one of the suggested causes for the depression of fibrinogen and gamma globulin during hormonal therapy. Depression of these proteins is not necessarily a primary effect of the hormones, but may be principally a reflection of the effect of the hormones on the inflammatory disease process present in the patients studied.The stimulus for producing excessive amounts of these proteins, particularly fibrinogen, and thereby effecting an elevation of the sedimentation rate, is usually an inflammatory reaction. This reaction is itself suppressed to a great degree during the period of hormone administration. Several studies, including our own, are summarized in the "Proceedings of the Second Clinical ACTH Conference" and have shown that many of the secondary results of various types of inflammatory reaction, such as
Fischel EE. CORTISONE AND ERYTHROCYTE SEDIMENTATION. JAMA. 1951;146(14):1340. doi:10.1001/jama.1951.03670140066025