The value of splenectomy and adrenocortical hormone therapy in idiopathic thrombocytopenic purpura are established. Should these fail, castration, androgen administration, or the removal of an accessory spleen may be considered. Because these measures are required infrequently, the literature regarding their efficacy is limited. The following case is reported, therefore, because of the opportunity it afforded to reassess this therapeutic problem. In addition, 3 facets of our patient's course were noteworthy. First, thrombocytopenic purpura developed long after an episode of hemolytic anemia. Secondly, therapy with prednisone after radiation castration was followed by an immediate increase in platelets, although prednisone and dexamethasone singly had previously failed to affect the thrombocytopenia. Finally, an attempt to demonstrate an accessory spleen with thorium dioxide (Thorotrast) proved misleading.
Report of Case
A 41-year-old housewife was admitted to the University of Minnesota Hospitals on July 24, 1959, because of thrombocytopenic purpura.The patient had had diabetes mellitus
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