The cytokine response in a patient undergoing surgery for an ACTH-producing tumor

The administration of glucocorticoids has been used to inhibit the cytokine production in patients undergoing cardiac surgery during cardiopulmonary bypass. In this case report the cytokine response in a 43-year-old man undergoing operation for an ACTH-producing lung tumor is presented. There had been clinical symptoms for about 18 months and 8 months before operation elevated serum concentrations of ACTH and cortisol were measured. The patient underwent thoracotomy with removal of the tumor and the cytokine response in relation to surgery was measured as plasma concentrations of IL-1 alpha, IL-6, TNF alpha and TNF beta. With the long-lasting high endogenous glucocorticoid production low or undetectable cytokine levels were expected in this patient. However, a marked and prolonged IL-6 and TNF beta response was measured while IL-1 alpha and TNF alpha were detectable in only a few samples. The cytokine response in this patient was different from the response normally found in patients undergoing major surgery.