Hormones & Arthritis

Betty S., daughter of a Manhattan TV writer, was stricken before her fourth birthday. What began as a sore throat and pain in the ankles soon developed into a full-blown case of Still's disease--he name given to rheumatoid arthritis when it attacks children. Betty was sent to a hospital for intensive care of her swollen joints. Main item in her treatment was heavy dosage with hormones of the cortisone family, which relieved her pain and kept her joints reasonably flexible. But Still's disease weakens a child's bones and hampers growth; ironically, cortisone aggravates that part of the problem. By a feedback mechanism in the body's complex interplay of hormones, cortisone tends to shut down the pituitary gland, source of the all-important growth hormone. In five years, Betty grew only four inches. Off cortisone for a while, she grew five more, but after that she seemed condemned to live out her life as a 4-ft. 1-in. dwarf.

Only from Man. Last week in Chicago, Drs. William H. Kammerer and Peter E. Stokes told the American Rheumatism Association that in the last 18 months, Betty has grown almost eight inches. Now 14, she is only about four inches short of the U.S. average. With her arthritis quiescent, she is still growing. The dramatic change took place because Betty is the first childhood arthritis patient to be treated, as a few victims of pituitary dwarfism* have been, with one of the most maddeningly hard-to-get substances known to medicine: human growth hormone, or HGH.

Extracts from animal glands (even some from the pituitary, such as ACTH) are easy to get and work well as replacement for many human hormones. Growth hormone is the exception for which the human body apparently insists on its own brand. (Monkeys' hormones would probably work, but the glands are too small.) Since HGH cannot yet be synthesized, the only source of supply is man. A few medical examiners seek authorization to remove the pea-sized pituitary at autopsies on both adults and stillborn babies. The tiny glands are sent to one of three university laboratories. There, after five or six days of exquisitely delicate chemical processes, each gland yields about one twenty-five-thousandth of an ounce of HGH. Because of its scarcity, HGH is only available for research, not for sale.

Betty S. now gets five injections a week, and each day's shot contains the HGH from three human glands. Until new sources of supply are developed, there will never be enough HGH, even for the relatively small number of children who need it. Meanwhile, some doctors have suggested that pituitaries, like corneas, should be willed to a gland bank. Plans for such a bank are now under study at the National Institutes of Health.

For Women Only. Even when this bank is in business, though, it will be no help to full-growth adult victims of rheumatoid arthritis. For them, the doctors at the Chicago meeting discussed a different but equally ingenious treatment. Since female sufferers who become pregnant usually get relief about the third month, asked Dr. Roger Demers of Quebec, why not try the effects of a pseudopregnancy? A condition resembling pregnancy so far as hormone balance is concerned can be produced by giving a woman heavy daily doses of norethynodrel (trade name: Enovid), which serves as an oral contraceptive when taken in smaller doses for only 20 days a month. Dr. Demers has tried out the idea on ten patients. All showed marked improvement after three months and were able to give up their cortisone-type drugs; four seemed completely well. But the treatment offers no hope for men because it may damage the testes.

* Children whose growth is arrested by a shutdown in the pituitary's output of growth hormone. Often the cause is unknown: sometimes it is a tumor.

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