Hemorrhagic Diathesis with Ascorbic Acid Deficiency During Administration of Anterior Pituitary Corticotropic Hormone (ACTH).

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Abstract
2 patients are described, who on ACTH therapy demonstrated the appearance of a hemorrhagic syndrome, characterized by the appearance of ecchymoses in response to light trauma to the skin. Coagulation studies revealed decreased plasma prothrombin and labile factor activity together with moderately increased fibrinolytic activity in one patient and subnormal capillary resistance in the other. None of these factors could account for the severe hemorrhagic diathesis. There were low plasma vit. C levels and low urinary vit. C excretion in both patients, low plasma ascorbic acid tolerance curve in the one patient studied, together with limited urinary excretion following 1 g. of ascorbic acid. Admn. of ascorbic acid corrected the hemorrhagic syndrome in both instances. It is suggested that ACTH admn. may precipitate a hemorrhagic syndrome by ascorbic acid depletion in some patients with predisposing subclinical abnormalities in hemostatic factors.