Article

Responses to Corticotropin (ACTH) and Cortisone in Thromrocytopenic States

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Abstract

SPLENECTOMY, considered to be the treatment of choice in idiopathic thrombocytopenic purpura (ITP), has not been attended by uniformly favorable results. Corticotropin (ACTH) and cortisone have recently been found to be effective in some instances of this disorder. This paper summarizes observations on 12 patients with thrombocytopenia of various types, and demonstrates the ability of the steroid hormones to reduce hemorrhagic tendencies even in the absence of a platelet response.

RESULTS

Of the 12 patients, seven had ITP (Table 1), three had thrombocytopenia following drug ingestion, one had thrombocytopenia associated with disseminated lupus erythematosus, and one had chronic lymphocytic leukemia treated by irradiation therapy (Table 2). All received corticotropin or cortisone or a combination of the two.

A sustained clinical and hematologic remission was not obtained in any of the seven patients who had ITP. Two of these received corticotropin alone. One experienced prompt cessation of the bleeding tendency unassociated with a rise in platelets. The other responded with a transient improvement in the hemorrhagic diathesis and a rise in platelets, but relapsed promptly on withdrawal of the drug. This response was obtained in a four year old boy (case 4) who had had a sudden onset of petechiae and epistaxis. The platelet count initially was 61,000 per cu. mm. (Dameshek). On the fourteenth day of treatment the platelet count was 536,000 per cu. mm. Treatment was stopped at this time, and approximately four weeks later the platelet count had dropped to 106,000 per cu. mm.

Four other patients with . . .


 

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