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On Feb. 12, 1959, purified corticotropin ( ACTH Gel ), 20 units daily intramuscularly, was started but had to be discontinued 3 weeks later because of excessive fluid retention.

From March 3 to May 1, 1949, the patient was maintained on dexamethasone, 3 to 6 mg. daily.

In May 1959, prednisone, 30 mg. daily, replaced the dexamethasone.

Muscle weakness did not improve, and the patient needed first a cane, then crutches.

In spite of normal thyroid function tests, a trial of propylthiouracil, 400 mg. daily for one week, was given but served only to intensify muscle weakness.

Repeated attempts to withdraw steroids entirely were unsuccessful because increased muscle weakness resulted, as well as fever, malaise, anorexia, anxiety, and an exacerbation of the anemia.

These reactions were interpreted as being manifestations of hypoadrenocorticism.