Brouwers A, et al. - Researchers here tested the claim that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. Results did not support the claim and suggested that hyperestrogenism occurs both in HOA and in simple clubbing. Results, in addition, supported that clubbing and HOA are associated with spider angiomas, palmar erythema, gynecomastia, adrenal cortical hyperfunction, muscle atrophy, and water retention. A new hypothesis was thereby made on the pathogenesis of HOA, involving estrogens, prostaglandin E2, prostaglandin A2, and the inflammatory reflex.

Methods

• Measurement of estrogens, androgens, sex hormone-binding globulin (SHBG), and gonadotropins was performed in five patients with HOA and in 18 patients with simple clubbing.

Results

• A high urinary estriol concentration was noticed in 80% of patients with HOA; in their serum, 80% had high estrone, 0% high estradiol, and 40% high SHBG.
• A high urinary estriol concentration was observed in 89% of the patients with simple clubbing; in their serum, 76% had high estrone, 6% high estradiol, and 31% high SHBG.
• In all patients, a positive correlation was noticed between urinary estriol concentration and the degree of clubbing.
• Mostly normal serum concentration of androstenedione, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) was observed, however, androstenedione concentration seemed to have a positive correlation with the degree of clubbing.
• In this study, spider angiomas were present in 74%, palmar erythema in 39%, and gynecomastia in 9%.
• In 48%, urinary creatinine concentration was low and had positive correlation with the degree of clubbing.