[A case of Marie-Bamberger syndrome caused by growth hormone-producing lung cancer: problems associated with peri- and postoperative management of patients with growth hormone-producing tumors from the standpoint of the "second attack" theory].
Marie-Bamberger syndrome is identical to pulmonary hypertrophic osteoarthropathy, and the causative factors have not been thoroughly clarified yet. Therefore, further studies of each case would seem to be useful to shed some light on the pathogenesis. We reported a 48-year-old man with primary lung cancer associated with clubbing of the fingers and hypertrophic osteoarthropathy. Chest CT portrayed a 10 x 6.5-cm bulky mass with central necrosis in the left upper lobe. The serum level of growth hormone (GH) showed about a twenty-fold increase over the normal upper limit. With the emergence of SIRS (Systemic Inflammatory Response Syndrome), the patient's general condition took a downhill course. We considered this state to be an oncological emergency and performed a semi-urgent operation. Immunohistochemical evaluation revealed a poorly differentiated adenocarcinoma with GH production. After treatment, the serum level of GH normalized and the clubbing and the periosteal changes of the bones resolved, which suggests that GH plays an etiologic role in Marie-Bamberger syndrome. Recent studies have indicated that GH has immunostimulatory effects. From the standpoint of the "second attack" theory, surgical stress seems to act on the immune system already activated by GH (so called "priming") in the form of a second attack, and trigger an excessive inflammatory response leading to postoperative organ injury in patients who suffer from GH-producing tumors. Thus, we should recognize this immanent risk and perform peri- and postoperative management for patients with GH-producing tumors.
Terashima
H
H
Department of Surgery and Pathology, Hiraka General Hospital, Yokote, Japan.
Saitoh
M
M
Takahashi
M
M
Shimada
T
T
Hirayama
K
K
D000230:Adenocarcinoma / Q000150:complications* / Q000378:metabolism; D013006:Growth Hormone / Q000096:biosynthesis*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000209:etiology*
D013006:Growth Hormone