Corticotropin (ACTH) and adrenal steroids are valuable adjuncts in the management of ulcerative colitis. These compounds do not cure the disease but constitute "therapeutic bridges," alleviating symptoms during critical stages of the illness when other measures are unsuccessful. However, these drugs may cause numerous side-effects, including edema, Cushing-like facies, acne, hypertension, glycosuria, hypokalemia, and an increased susceptibility to infection. Perforation of the bowel wall and peritonitis, a not infrequent complication of ulcerative colitis before the advent of steroids, also has been attributed to steroids. In most instances, the cause-and-effect relationship has been assumed chiefly on the basis of chronological sequence.
To evaluate the role of corticotropin and adrenal steroids in perforation of the bowel in ulcerative colitis, a comparative study was undertaken of the frequency of this complication in the presteroid and steroid eras.1 Perforation of the bowel wall in ulcerative colitis not infrequently has complicated the disease in
Goldgraber MB, Kirsner JB, Palmer WL. Ulcerative ColitisThe Risk of Perforation During Adrenal Steroid Therapy. AMA Arch Intern Med. 1957;100(2):180–182. doi:10.1001/archinte.1957.00260080006003