Ito Katsuhiro, Uchida Toshihiro, Manabe Yumi, Miyazaki Yu, Itoh Haruki, Mishina Mutsuki, Okuno Hiroshi
The Department of Urology, National Hospital Organization Kyoto Medical Center.
Hinyokika Kiyo. 2018 Oct;64(10):391-395. doi: 10.14989/ActaUrolJap_64_10_391.
A 66-year-old man had undergone multiple treatments for metastatic renal cell carcinoma, including 11 cycles of nivolumab, which was discontinued because of disease progression. About three weeks after discontinuing nivolumab, he reported suffering from worsening of dyspnea. Pulse oximetry showed no desaturation. His cardiovascular and pulmonary functions were normal. His dyspnea slowly worsened with no underlying diagnosis. Two months after symptoms developed, he was diagnosed with isolated adrenocorticotropic hormone deficiency. His dyspnea disappeared soon after receiving hydrocortisone. Nivolumab-induced isolated adrenocorticotropic hormone deficiency may not present with typical symptoms, and can occur even after discontinuing nivolumab. Cortisol levels should be routinely monitored in patients who receive nivolumab.
一名66岁男性因转移性肾细胞癌接受了多种治疗，包括11个周期的纳武单抗治疗，后因疾病进展而停药。停用纳武单抗约三周后，他报告呼吸困难加重。脉搏血氧饱和度测定显示无血氧饱和度下降。他的心血管和肺功能正常。在没有明确潜在病因的情况下，他的呼吸困难逐渐加重。症状出现两个月后，他被诊断为孤立性促肾上腺皮质激素缺乏症。接受氢化可的松治疗后不久，他的呼吸困难消失了。纳武单抗引起的孤立性促肾上腺皮质激素缺乏症可能不表现出典型症状，甚至在停用纳武单抗后仍可能发生。接受纳武单抗治疗的患者应常规监测皮质醇水平。
