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Is steroid therapy in multiple sclerosis superior to corticotropin therapy?

In Reply. —In reply to the letter by Davis and Stefoski 1 we agree that the discovery of corticotropin receptors on lymphocytes and the secretion of corticotropinlike substances by lymphocytes is a provocative area for investigation. These observations will be important if it can be shown that the direct effect of corticotropin on lymphocytes causes clinically significant effects on immunoregulation. The syndrome of corticotropin insensitivity has been reported in over 60 patients. These patients have presented with hyperpigmentation, hypoglycemia, low serum cortisol levels, adrenal unresponsiveness to corticotropin stimulation, and high serum corticotropin levels. In a recent case report of a young child, the corticotropin insensitivity syndrome was associated with an absence of high-affinity corticotropin receptors on circulating peripheral mononuclear leukocytes. 2 The patient did have recurrent infections while hypoglycemic with very low serum cortisol levels. However, while maintained on cortisol replacement therapy, the patient has remained clinically stable for years