Fosci Michele, Pigliaru Francesca, Salcuni Antonio Stefano, Ghiani Massimo, Cherchi Maria Valeria, Calia Maria Antonietta, Loviselli Andrea, Velluzzi Fernanda
Department of Medical Sciences, University of Cagliari, Azienda Universitaria-Ospedaliera of Cagliari, Cagliari, Sardegna, Italy.
Department of Medical Oncology, Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy.
Endocrinol Diabetes Metab Case Rep. 2021 Jan 27;2021. doi: 10.1530/EDM-20-0123.
A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibulo-neurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted.
A remarkable risk of endocrine immune-related adverse events (irAEs) during therapy with checkpoint inhibitors exsists. In order to ensure maximum efficiency in the recognition and treatment of endocrine iRAes related to immune checkpoint inhibitors, multidisciplinary management of oncological patients is critical. The pituitary syndrome in oncological patients who underwent immunotherapy represents a challenge in the differential diagnosis between pituitary metastasis and drug-induced hypophysitis. This is the first case, described in the literature of diabetes insipidus in a patient suffering from nivolumab-induced infundibulo-neurohypophysitis and anterohypophyseal metastasis.
一名62岁的下咽癌转移患者接受了纳武单抗治疗，之后出现了提示尿崩症的症状。停用纳武单抗并开始使用甲泼尼龙治疗。在皮质类固醇治疗期间，患者健康状况不佳，出现真菌感染和血糖失代偿。逐渐减少甲泼尼龙剂量，导致霉菌病消退和血糖代偿恢复，但多尿和烦渴仍持续存在。给予去氨加压素后尿渗透压升高，提示可能诊断为中枢性尿崩症。垂体MRI扫描加钆剂的神经放射学数据与转移灶定位和纳武单抗治疗继发的漏斗-神经垂体炎并存相符。为明确垂体病变的确切病因，有必要进行组织学证实；然而，不幸的是，这无法做到。在没有组织学证实的情况下，我们认为两种病变可能并存。
在检查点抑制剂治疗期间，存在显著的内分泌免疫相关不良事件（irAEs）风险。为确保在识别和治疗与免疫检查点抑制剂相关的内分泌irAEs方面达到最大效率，肿瘤患者的多学科管理至关重要。接受免疫治疗的肿瘤患者的垂体综合征在垂体转移和药物性垂体炎的鉴别诊断中是一项挑战。这是文献中描述的首例因纳武单抗诱导的漏斗-神经垂体炎和垂体前叶转移而导致尿崩症的病例。
