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1/7. Hypertrophic pulmonary osteoarthropathy associated with non-small cell lung cancer demonstrated growth hormone-releasing hormone by immunohistochemical analysis.

    Hypertrophic pulmonary osteoarthropathy (HPO) associated with non-small cell lung cancer in a 58-year-old man was accompanied by an elevated serum level of growth hormone (GH). HPO rapidly disappeared after resection of the primary tumor and the elevation of serum GH was resolved. Immunohistochemically the tumor contained growth hormone-releasing hormone (GHRH) but not GH. These findings suggest that the high serum GH level due to ectopic GHRH production in the tumor, was a contributing factor in HPO. This is the second reported case of non-small cell lung cancer which was immunohistochemically positive for GHRH associated with HPO.
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keywords = osteoarthropathy
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2/7. Hypertrophic pulmonary osteoarthropathy without clubbing of the digits.

    Hypertrophic osteoarthropathy (HOA) typically occurs concurrently with clubbing of the digits, with isolated HOA being reported only rarely. We report two patients with intra-thoracic malignancy in whom HOA, demonstrated on bone scintigraphy, developed in the absence of clubbing. We also report the novel observation of involvement of the metatarsal and metacarpal bones by HOA.
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ranking = 1
keywords = osteoarthropathy
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3/7. Successful treatment of hypertrophic osteoarthropathy by gefitinib in a case with lung adenocarcinoma.

    Hypertrophic osteoarthropathy is an important manifestation of lung carcinoma, particularly in a non-small cell tumor, and hampers quality of life. Although removal of the primary tumor usually resolves this syndrome, effective treatment in patients with advanced lung carcinoma has not been established. Recently, an orally active, selective epidermal growth factor receptor tyrosine kinase (EGFR) inhibitor ("Gefitinib") provided clinical anti-tumor activity. We describe a 71-year-old male smoker with cough, who presented with clubbed fingers. A transbronchial lung biopsy (stage T2N3M1-IV) on a cavity lesion in the left lower lobe showed the features of adenocarcinoma, while bone scintigram revealed bilaterally symmetrical abnormal uptakes in the lower extremities, suggesting secondary hypertrophic osteoarthropathy. The serum level of growth hormone was increased to 1.42 ng/ml. Chemotherapy (cisplatin, vinorelbine) was not effective. Gefitinib, as a second-line therapy, induced disappearance of the abnormal accumulation on bone scintigraphy and decrease of the cavity in the lung and of serum growth hormone. The presented case suggests that the EGFR inhibitor might be a promising option for the treatment of hypertrophic osteoarthropathy with advanced lung adenocarcinoma.
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ranking = 1.4
keywords = osteoarthropathy
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4/7. Hypertrophic osteoarthropathy pathogenesis: a case highlighting the potential role for cyclo-oxygenase-2-derived prostaglandin E2.

    BACKGROUND: A 65-year-old woman presented with weakness, 9 kg weight loss, dysphagia, facial and bilateral upper-extremity swelling, and debilitating, bilateral lower-extremity pain. The patient had undergone a right upper lobectomy for a 5 mm, poorly differentiated adenocarcinoma of the lung 4 years previously. Medical history included chronic obstructive pulmonary disease (emphysema), hypertension, cerebrovascular disease and multinodular goiter. Surgical history included a right carotid endarterectomy. The patient's history was remarkable for 50 pack-years of smoking. INVESTIGATIONS: physical examination, comprehensive metabolic panel and complete blood counts, CT, bone scintigraphy, quantification of urinary 11a-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (also known as PGE-M). diagnosis: Recurrent non-small-cell lung cancer with adrenal metastasis, hypertrophic osteoarthropathy associated with non-small-cell lung cancer, and hyperprostaglandinuria. MANAGEMENT: Rofecoxib 25 mg daily for hypertrophic osteoarthropathy, palliative external-beam radiation (44 Gy in 22 fractions) for mediastinal mass, palliative external-beam radiation (30 Gy in 12 fractions), followed 2 years later with radiofrequency ablation, for left adrenal metastasis.
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ranking = 1.2
keywords = osteoarthropathy
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5/7. Non-small-cell lung cancer with multiple paraneoplastic syndromes.

    We describe the case of a patient with multiple paraneoplastic syndromes, six in total, associated with a non-small-cell cancer of the lung. In this single patient we found hypertrophic pulmonary osteoarthropathy, hyperkeratosis of palms and soles, erythema annulare centrifugum, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ectopic andrenocorticotrophic hormone (ACTH) and calcitonin production.
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ranking = 0.2
keywords = osteoarthropathy
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6/7. lung cancer containing growth hormone-releasing hormone associated with hypertrophic osteoarthropathy. Case report.

    In a 49-year-old man, large-cell carcinoma of the lung was accompanied by raised serum levels of growth hormone (GH) and growth hormone-releasing hormone (GHRH) and hypertrophic osteoarthropathy. Immunohistochemically the tumour contained GHRH but not GH. The osteoarthropathy disappeared after resection of the primary tumour and did not reappear after its recurrence. The high serum GH level presumably was due to ectopic GHRH production in the tumour. The hypertrophic osteoarthropathy was not clearly attributable to these hormones.
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ranking = 1.4
keywords = osteoarthropathy
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7/7. The use of pamidronate in hypertrophic pulmonary osteoarthropathy (HPOA).

    BACKGROUND: Hypertrophic pulmonary osteoarthropathy (HPOA) secondary to bronchogenic carcinoma can be associated with severe, disabling pain which is not always responsive to conventional treatment. AIM: To report on the use of pamidronate to control resistant pain in HPOA in three cases. methods: A retrospective review of reported pain, chest X-ray and radionuclide bone scans was made. RESULTS: pain relief was achieved in all three cases together with reduced radiolabel uptake in two cases. CONCLUSIONS: Pamidronate appears to be an effective therapy for HPOA. Further investigation is warranted.
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ranking = 1
keywords = osteoarthropathy
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