Mishima Yuka, Fukaishi Takahiro, Inase Naohiko, Isogai Susumu
Respiratory Medicine, Ome Municipal General Hospital, Japan.
Endocrinology and Metabolism, Ome Municipal General Hospital, Japan.
Intern Med. 2019 Mar 1;58(5):693-697. doi: 10.2169/internalmedicine.1268-18. Epub 2018 Nov 19.
Nivolumab-induced multiple organ immune-related adverse events (irAEs) have been described in some case reports. The symptoms of endocrinological irAEs are especially nonspecific. A 63-year-old man with a postoperative recurrence of pulmonary adenocarcinoma who was treated with nivolumab presented fever, anorexia and fatigue after the 7th cycle. He underwent a rapid adrenocorticotrophic hormone test, four-hormone tolerance test and thyroid gland scintigraphy. The results were consistent with destructive thyroiditis, hypophysitis and secondary adrenal insufficiency. Nivolumab was restarted following glucocorticoid and thyroid hormone replacement treatment. When a patient presents nonspecific symptoms, the possibility of endocrinological irAEs should be considered as it may enable their early detection.
一些病例报告中描述了纳武单抗诱导的多器官免疫相关不良事件（irAEs）。内分泌irAEs的症状尤其不具有特异性。一名63岁的肺腺癌术后复发患者接受纳武单抗治疗，在第7个周期后出现发热、厌食和疲劳。他接受了促肾上腺皮质激素快速试验、四项激素耐量试验和甲状腺闪烁扫描。结果与破坏性甲状腺炎、垂体炎和继发性肾上腺功能不全一致。在糖皮质激素和甲状腺激素替代治疗后重新开始使用纳武单抗。当患者出现非特异性症状时，应考虑内分泌irAEs的可能性，因为这可能有助于早期发现。
