Sato Yozo, Tanaka Yosuke, Hino Mitsunori, Seike Masahiro, Gemma Akihiko
Respiratory Disease Center, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Respir Med Case Rep. 2019 Jan 28;26:223-226. doi: 10.1016/j.rmcr.2019.01.021. eCollection 2019.
One of the novel PD-1 antibodies/immune checkpoint inhibitors, nivolumab is reported to be associated with a wide range of immune-related adverse events (irAEs). We hereby report a case of isolated adrenocorticotropic hormone (ACTH) deficiency developing in a patient with squamous cell lung cancer (SCC) during nivolumab therapy.
A 79-year-old man with SCC was started on nivolumab therapy as a fifth-line treatment after 4 lines of cytotoxic anticancer therapy. After 20 courses of nivolumab therapy, he had nausea, appetite loss, and difficulty walking. A close laboratory examination led to the diagnosis of isolated ACTH deficiency in this patient. Hydrocortisone replacement therapy led to amelioration of his symptoms and allowed him to continue with nivolumab therapy. The present case of isolated ACTH deficiency was characterized by a slowly progressive decline in the serum sodium level, which became manifest well before appearance of any clinical symptoms, suggesting that the serum sodium level may be used to predict progression to isolated ACTH deficiency.Thus, not only serum sodium levels need to be monitored in patients suspected of having isolated ACTH deficiency, but ACTH and cortisol levels need to be monitored in those exhibiting a decline in serum sodium levels. Again, nivolumab-induced isolated ACTH deficiency needs to be appropriately diagnosed and treated to ensure that patients continue with, and maximize survival benefit from, nivolumab therapy.
纳武单抗是一种新型的程序性死亡受体-1（PD-1）抗体/免疫检查点抑制剂，据报道与多种免疫相关不良事件（irAEs）有关。我们在此报告一例鳞状细胞肺癌（SCC）患者在接受纳武单抗治疗期间发生孤立性促肾上腺皮质激素（ACTH）缺乏的病例。
一名79岁的SCC男性患者在接受4线细胞毒性抗癌治疗后，开始接受纳武单抗作为五线治疗。在接受20个疗程的纳武单抗治疗后，他出现恶心、食欲减退和行走困难。详细的实验室检查导致该患者被诊断为孤立性ACTH缺乏。氢化可的松替代治疗使他的症状得到改善，并使他能够继续接受纳武单抗治疗。本例孤立性ACTH缺乏的特点是血清钠水平缓慢进行性下降，在任何临床症状出现之前就已明显，这表明血清钠水平可用于预测进展为孤立性ACTH缺乏。因此，不仅需要对疑似孤立性ACTH缺乏的患者监测血清钠水平，而且需要对血清钠水平下降的患者监测ACTH和皮质醇水平。同样，需要对纳武单抗诱导的孤立性ACTH缺乏进行适当的诊断和治疗，以确保患者能够继续接受纳武单抗治疗并最大限度地从该治疗中获得生存益处。
