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Brouwers A, Dingjan PG, Dujardin B, van Zoelen EJ, Lips P, Gooren LJ. Hypertrophic osteoarthropathy: estrogens, prostaglandinE 2, prostaglandin A 2, and the inflammatory reflex. Clin Rheumatol 2018; 38:211-222. [PMID: 29480386 DOI: 10.1007/s10067-018-4044-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
It has been claimed that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. However, one of our patients had simple clubbing and hyperestrogenism. We therefore measured estrogens, androgens, sex hormone-binding globulin (SHBG), and gonadotropins in five patients with HOA and in 18 patients with simple clubbing. Of the patients with HOA, 80% had a high urinary estriol concentration. In their serum, 80% had high estrone, 0% high estradiol, and 40% high SHBG. Of the patients with simple clubbing, 89% had a high urinary estriol concentration. In their serum, 76% had high estrone, 6% high estradiol, and 31% high SHBG. In all patients, urinary estriol concentration correlated positively with the degree of clubbing. Serum concentration of androstenedione, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) was mostly normal, but androstenedione concentration correlated positively with the degree of clubbing. Spider angiomas were present in 74%, palmar erythema in 39%, and gynecomastia in 9%. Urinary creatinine concentration was low in 48% and correlated positively with the degree of clubbing. We reject the claim that hyperestrogenism occurs in HOA, but not in simple clubbing. Hyperestrogenism occurs both in HOA and in simple clubbing. Our results also support earlier reports that clubbing and HOA are associated with spider angiomas, palmar erythema, gynecomastia, adrenal cortical hyperfunction, muscle atrophy, and water retention. These results led to a new hypothesis on the pathogenesis of HOA, involving estrogens, prostaglandin E2, prostaglandin A2, and the inflammatory reflex.
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Affiliation(s)
- Ad Brouwers
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands. .,, Wageningen, The Netherlands.
| | - Pieter G Dingjan
- Department of Clinical Chemistry, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Ben Dujardin
- Department of Clinical Chemistry, Gelderse Vallei Hospital, Ede, The Netherlands.,, Ede, The Netherlands
| | - Everardus J van Zoelen
- Department of Cell and Applied Biology Nijmegen, Centre for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands.,, Oosterbeek, The Netherlands
| | - Paul Lips
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,, Amsterdam, The Netherlands
| | - Louis J Gooren
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,, Chiang Mai, Thailand
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Babyn P, Peled N, Manson D, Dagan O, Silver MM, Koren G. Radiologic features of gastric outlet obstruction in infants after long-term prostaglandin administration. Pediatr Radiol 1995; 25:41-3; discussion 44. [PMID: 7761161 DOI: 10.1007/bf02020842] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Long-term prostaglandin (PG) therapy has recently been associated with gastric mucosal hyperplasia. We reviewed the clinical and radiologic (especially sonographic) records of eight patients with complex congenital heart disease who were on PG therapy. Feeding problems, vomiting, and abdominal distension were present in six patients. Barium meal revealed antral narrowing in three patients, suggestive of hypertrophic pyloric stenosis in two. Sonography showed a variable degree of increased gastric mucosal lobulation often accompanied by a marked polypoid or lobular appearance. Cortical hyperostosis related to PG therapy was seen in three patients. PG-associated gastric mucosal hyperplasia can cause feeding problems and pronounced gastric lobulation.
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Affiliation(s)
- P Babyn
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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