Zutshi D W, Friedman M, Ansell B M
Arch Dis Child. 1971 Oct;46(249):584-93. doi: 10.1136/adc.46.249.584.
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because (a) growth can be maintained, and (b) once the acute symptoms are brought under control, ACTH can be withdrawn without difficulty.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 If corticosteroid therapy cannot be withdrawn well before puberty, then conversion to ACTH should be seriously considered, in order to gain the advantage of the pubertal growth spurt.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.
促肾上腺皮质激素（ACTH）疗法能令人满意地控制斯蒂尔病的急性全身症状。在这类特殊患者中，ACTH治疗优于口服皮质类固醇，原因如下：（a）可维持生长；（b）一旦急性症状得到控制，停用ACTH并不困难。另一方面，使用ACTH时关节炎更难控制，此时其作用很可能是一种临时措施，以待其他药物（如金制剂）起效。如果在青春期前不能顺利停用皮质类固醇疗法，那么应认真考虑改用ACTH，以便利用青春期生长突增的优势。ACTH的剂量应旨在促使内源性ACTH产生。这可通过在给予ACTH 48小时后测量上午9点的静息血浆皮质醇水平来判断。同时使用ACTH和皮质类固醇会损害下丘脑 - 垂体 - 肾上腺轴的功能。
