Secondary Adrenal Insufficiency Due to Isolated ACTH Deficiency Induced by Pembrolizumab: A Report of Two Cases of Uterine Endometrial Cancer

被引:0
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作者
Onoyama, Ichiro [1 ]
Kawakami, Minoru [1 ]
Hachisuga, Kazuhisa [1 ]
Maenohara, Shoji [1 ]
Kodama, Keisuke [1 ]
Yagi, Hiroshi [1 ]
Yasunaga, Masafumi [1 ]
Ohgami, Tatsuhiro [1 ]
Asanoma, Kazuo [1 ]
Yahata, Hideaki [1 ]
Kitamura, Yuya [2 ]
Sakamoto, Ryuichi [2 ]
Kiyozawa, Daisuke [3 ]
Kato, Kiyoko [1 ]
机构
[1] Kyushu Univ, Grad Sch Med Sci, Dept Obstet & Gynecol, Higashi Ku, Fukuoka 8128582, Japan
[2] Kyushu Univ, Grad Sch Med Sci, Dept Med & Bioregulatory Sci, Higashi Ku, Fukuoka 8128582, Japan
[3] Kyushu Univ, Grad Sch Med Sci, Dept Anat Pathol, Higashi Ku, Fukuoka 8128582, Japan
关键词
pembrolizumab; immune-related adverse event; isolated ACTH deficiency; endometrial cancer; BENEFIT;
D O I
10.3390/reports6020018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Immune checkpoint inhibitors (ICIs) enhance antitumoral immune mechanisms and are used to treat various types of solid tumors including those that are microsatellite instability (MSI)-high. Uterine endometrial cancer is one of the most frequent tumor types that shows MSI-high, and, consequently, opportunities to use ICIs for endometrial cancer treatment are increasing. While using ICIs, it is important to monitor and manage various immune-related adverse events (irAEs). Here, we report two cases of secondary adrenal insufficiency during treatment of endometrial cancer with pembrolizumab. Both cases showed appetite loss and general fatigue after the 6th or 12th cycle of pembrolizumab. They were admitted to our hospital because of remarkable hyponatremia. Both cases showed no adrenocorticotropic hormone (ACTH) or cortisol response to CRH loading tests. Other pituitary hormone levels were normal, and MRI revealed no sign of hypophysitis in either patient. They were diagnosed with secondary adrenal insufficiency due to isolated ACTH deficiency and recovered soon after the administration of hydrocortisone and hydration. Thus, we should be aware of irAEs with the use of ICIs. In particular, adrenocortical insufficiency is sometimes lethal without appropriate treatment. Because the clinical symptoms are fatigue, appetite loss, and nausea, patients might be misjudged to have symptoms related to cancer. Checking serum morning cortisol before ICIs use and monitoring serum sodium levels could provide clues to diagnose secondary adrenal insufficiency.
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页数:7
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  • [1] SECONDARY CHRONIC ADRENAL FAILURE DUE TO AN ISOLATED ACTH DEFICIENCY - REPORT BASED ON 2 CLINICAL CASES
    DELATORRE, MG
    COMINO, MS
    RODRIGUEZ, GF
    FRANCO, FS
    RODRIGUEZ, JP
    RIOS, MS
    [J]. REVISTA CLINICA ESPANOLA, 1989, 184 (06): : 307 - 310
  • [2] ADRENAL INSUFFICIENCY DUE TO ISOLATED CORTICOTROPIC DEFICIENCY - 2 CASES
    AUBERT, P
    LAINEE, J
    DURON, F
    [J]. NOUVELLE PRESSE MEDICALE, 1976, 5 (34): : 2227 - 2230
  • [3] Ampulla (Takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency
    Sakihara, Satoru
    Kageyama, Kazunori
    Nigawara, Takeshi
    Kidani, Yukie
    Suda, Toshihiro
    [J]. ENDOCRINE JOURNAL, 2007, 54 (04) : 631 - 636
  • [4] Simultaneous Presentation of Secondary Adrenal Insufficiency and Primary Hypothyroidism due to Pembrolizumab: A Case Report
    Khatri, Shivam
    Alom, Mulham
    Kashfi, Simon
    Atallah, Jane
    Goswami, Gayotri
    [J]. JOURNAL OF INVESTIGATIVE MEDICINE HIGH IMPACT CASE REPORTS, 2023, 11
  • [5] Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report
    Fujimiya, Tatsuhiro
    Azuma, Kanako
    Togashi, Yuki
    Kuwata, Koji
    Unezaki, Sakae
    Takeuchi, Hironori
    [J]. JOURNAL OF PHARMACEUTICAL HEALTH CARE AND SCIENCES, 2024, 10 (01)
  • [6] Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report
    Tatsuhiro Fujimiya
    Kanako Azuma
    Yuki Togashi
    Koji Kuwata
    Sakae Unezaki
    Hironori Takeuchi
    [J]. Journal of Pharmaceutical Health Care and Sciences, 10
  • [7] Adrenal insufficiency induced by megestrol acetate: Report of two cases
    Maria Garcia-Castells, Alia
    Argente-Pla, Maria
    Garcia-Malpartida, Katerinne
    Querol-Ripoll, Roser
    Francisco Merino-Torres, Juan
    [J]. ENDOCRINOLOGIA Y NUTRICION, 2015, 62 (10): : 515 - 516
  • [8] Isolated adrenocorticotropin deficiency induced by pembrolizumab for hypopharyngeal cancer: A case report
    Yamamoto, Koichiro
    Tokumasu, Kazuki
    Oka, Kosuke
    Hasegawa, Kou
    Otsuka, Fumio
    [J]. CLINICAL CASE REPORTS, 2021, 9 (06):
  • [9] A Rare Cause of Adrenal Insufficiency - Isolated ACTH Deficiency Due to TBX19 Mutation: Long-Term Follow-Up of Two Cases and Review of the Literature
    Al, Asli Derya Kardelen
    Poyrazoglu, Sukran
    Aslanger, Ayca
    Yesil, Gozde
    Ceylaner, Serdar
    Bas, Firdevs
    Darendeliler, Feyza
    [J]. HORMONE RESEARCH IN PAEDIATRICS, 2020, 92 (06): : 395 - 403
  • [10] Breastfeeding Failure Secondary to Idiopathic Isolated Prolactin Deficiency: Report of Two Cases
    Callejas, Leyda
    Berens, Pamela
    Nader, Shahla
    [J]. BREASTFEEDING MEDICINE, 2015, 10 (03) : 183 - 183