Ankov, V.

Koev, Y.

Koeva, L.

Mavrodinova, T.

Zlatanov, Z.

English

Varna Medical University Press: Journals

1 PLASMA GROWTH HORMONE L E V E L AND HYPERTROPHIC OSTEOARTHROPATHY IN PATIENTS WITH CARCINOMA L. Koeva, T. Mavrodinova, Y. Koev, Z. Zlatanov, V. Ankov Hypertrophic osteoarthropathy ( H O A P ) is one of the most frequently met paraneoplastic syndromes in pulmonary carcinoma (1 , 7). I t is marked c l in ica l ly by joint pains, drumstick (clubbed) fingers, pericstosis of long bones and neurovegetative disturbances — usually perspiration and reddening or paleness of the palms and soles.(4). Although the pathogenesis of hypertro-phic osteoarthropathy is not ful ly clarified, it is presumed that enhanced growth hormone secretion from the neoplastic cells plays an essential role (2, 3, 6). To furthermore clarify the role of growth hormone in the pathogenesis of hypertrophic osteoarthropathy, we undertook the task to study the plasma level of this particular hormone in pulmonary carcinoma patients. Material and method The plasma level of the somatotrophic hormone was investigated in a series of eighteen patients wi th lung carcinoma — males aged from 47 to 77 years. The tumour displayed central localization in seven cases, and peripheral — in three. Diagnosis was established following thorough c l in i ca l , X - r a y and bronchoscopic study. I n twelve patients the diagnosis was confirmed histolo-gical ly . Ten patients presented manifestations of hypertrophic osteoarthro-pathy while in the remainder they were lacking. Growth hormone investiga-tions in the plasma were conducted using the radioimmune method. Accord-ing to earlier researches wi th the latter, the values of growth hormone ( G H ) in healthy individuals range from 1.6 to 4 ng/ml. Results The mean G H level in the plasma of patients wi th lung carcinoma and H O A P amounts to 11.2zt5.1 ng/ml, wi th variations ranging from 4.9 to 22.5 ng/ml. The impression is that the highest G H values are recorded in pa-tients wi th strongly manifested and widespread H O A P (Table 1). I n a l l patients of the series the plasma G H level is above the uppermost l imi t for healthy individuals . I n group I I , including patients wi th lung carcinoma free of H O A P , the G H level averages 2.0=1=1.0 ng/ml, wi th variations ranging from 0.4 to 3.1 ng/ml I n a l l cases of this group the G H values are either wi th in normal l imi t s , or reduced (Table 2). Plasma growth hormone level and hypertrophic. 117 T a b l e 1 Plasma Growth Hormone Level in Patients with Pulmonary Carcinoma and Hypertrophic Osteoarthropathy. 1. V. A.S. 2. I .I .I . 3. J . I . I . 4. G. S. P. 5. G . G. S. 6. V . S. M 7. P. G. T. 8. G. I . P. 9. D. A. B. 10. V. A. K. 22,5 15,9 13,0 12,3 11,4 9,8 8,6 8,8 6,2 4,9 + + + + + + + + + ++ + + -f-+ + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + -f + + + + + + + + + + ++ + + + + Adenocarcinoma Adenocarcinoma Flat-cell Flat-cell Flat-cell Undifferentiated Flat-cell Flat-cell T a b l e 2 Growth Hormone Levei in Patients with Pulmonary Carcinoma Free of Hypertrophic Osteoarthropathy Name GH level ngyml Drum­stick fingers Arthral­gia Periostosis Histologial appearance 1 Phalan- Wrists ges Fore­arms Legs Feet 1. G. P. I . 2. Y. N. K. 3. G. S. K. 4. I . К. I . 5. T. G. R. 6. Ch. H. Bh. 7. D. A. M. 8. I.G. S. 3.1 3,1 3,0 2.2 2,0 1,3 1,2 0,4 — 1++1 I I 1 I — — — Undifferentiated Undifferentiated Undifferentiated Flat-cell X ± 2 . 0 ± N , O. ng/ml Discussion The results of the study demonstrate the close relationship exist ing be­tween the manifestations of hypertrophic osteoarthropathy and plasma G H level . A reliable G H rise is recorded among patients w i th lung carcinoma and H O A P , as compared to patients wi th lung Ca without H O A P . Moreover, the heavier degree of H O A P is usual ly associated wi th a higher G H level i n the plasma. Th i s is a convincing proof that enhanced G H secretion is the cause of H O A P in pulmonary carcinoma patients.Literature data on the issue point to the fact thatmost l i ke ly , the intensified secretion is accomplished by the tumorous cells themselves (2, 5) and by no means by the pi tu i tary gland. Steiner et a l (6) published a case report concerning a patient wi th pulmonary carcinoma + hypertrophic osteoarthropathy and elevated plasma G H level . Fol lowing ope­ra t ive removal of the neoplasm, the level of the hormone returned to normal, 1 118 L. Koeva, Т. Mavrodinova, D. Кое v . . . and a l l art icular phenomena subsided. Greenberg (2) succeeded in demonstrat­ing that isolated cells from pulmonary carcinoma in cell culture secrete growth hormone. The relationship between histological appearance of lung carcinoma and its capacity to secrete growth hormone is not sufficiently elucidated as yet. Sparagna and co-workers (5) established a considerably elevated G H con­tent in the neoplastic tissue of a patient wi th lung carcinoma and hypertrophic osteoarthropathy. Among our patients wi th carcinoma and H O A P there are cases wi th adenocarcinoma, although patients wi th flat cell carcinoma predo­minate, as wel l as a case wi th undifferentiated prickle cell carcinoma. Out of the three patients wi th carcinoma, free of hypertrophic osteoarthropathy, sub­jected to histological investigation, two are wi th undifferentiated carcinoma, and one—with flat cell carcinoma. I t seems that flat cell carcinoma is often as­sociated wi th hypertrophic osteoarthropathy, but the l imited number of pa­tients studied does not justify a definitive statement on the issue. , i t Conclusions 1. I n patients wi th lung carcinoma+hypertrophic osteoarthropathy the plasma level of G H is elevated, whereas in patients wi th lung carcinoma, free of hypertrophic osteoarthropathy, it is wi th in normal l imi t s . 2. No relationship whatsoever is established between histological ap­pearance of the carcinoma and plasma G H level . 3. The occurrence of hypertrophic osteoarthropathy in conjunction wi th pulmonary carcinoma is most l ike ly provoked by the paraneoplastic secretion of growth hormone. R E F E R E N C E S 1. P е й H б е p г, С. А. Клин, мед., 3, 17—30, 1954. — 2. G r e e n b e r g , Р. В . Lancet, 4, 350, 1972. — 3. L a w r e n c e , A. M. Ann. Clin. Sci. 3, 4, 259—264, 1973. — 4. S h u 1 m a n, E . L . , J . J . В u n i m. Hypertrophic osteoarthropathy. Principles of Internal Medicine. New York-Toronto-London, Mc Graw—Hill , 1920, 1966. — 5. S p a ­r a g n a , M., G . P h i l l i p s , C. H o f f m a n , L . K u c e r a . Metabolism, 20, 1974, 730. — 6. S t е i n е r, H . , O. D a h 1 b а с к, J . W a 1 d е n s t r o m. Lancet, 1, 783, 1968. — 7. W i е r m a n, W., О. Т. С 1 a d е t, J . R. M c D o n a l d . J. Amer. Med. Assoc., 155, 17, 1459—1463. 1954. Plasma growth hormone level and hypertrophic. 119 УРОВЕНЬ СОМАТОТРОПНОГО ГОРМОНА В ПЛАЗМЕ КРОВИ И ГИПЕРТРОФИЧЕСКАЯ ОСТЕОАРТРОПАТИЯ У БОЛЬНЫХ С РАКОМ ЛЕГКОГО Л. Коева, Т. Мавродинова, Д. Коев, Зл. Златанов, В. Анков Р Е З Ю М Е Исследован уровень соматотропного гормона в плазме крови у 18 муж­чин с раком легкого , среди которых 10 с гипертрофической остеоартропатией. Установлено, что у больных с гипертрофической остеоартропатией сома-тотропный гормон достоверно повышен, в сравнении со здоровыми лицами, в то время к а к у больных без гипертрофической остеоартропатии он нахо­дится в пределах нормы; не обнаружена с в я з ь между гистологическим ви­дом р а к а и уровнем соматотропного гормона в плазме крови . Предполага­ется , что появление гипертрофической остеоартропатии при р а к е легкого вызвано паранеопластической секрецией соматотропного гормона. 

PLASMA GROWTH HORMONE LEVEL AND HYPERTROPHIC OSTEOARTHROPATHY IN PATIENTS WITH CARCINOMA

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PLASMA GROWTH HORMONE LEVEL AND HYPERTROPHIC OSTEOARTHROPATHY IN PATIENTS WITH CARCINOMA

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