Omata Wataru, Nakamura Satoko, Urasaki Chie, Morita Hiromichi, Funaishi Hiroki, Kobayashi Kazuki, Koide Hisashi, Tsutsumida Arata, Matsue Hiroyuki
Department of Dermatology, Asahi General Hospital, Chiba, Japan.
Department of Diabetes and Metabolism, Asahi General Hospital, Chiba, Japan.
Case Rep Dermatol. 2022 Mar 21;14(1):55-60. doi: 10.1159/000523798. eCollection 2022 Jan-Apr.
We report a case of secondary adrenal insufficiency due to nivolumab. An 83-year-old man with acral lentiginous types of melanoma on the right sole visited our department in March 2017. He received primary surgery at referred hospital in June 2017, and pathological stage was IIIC (pT3bN3M0) according to AJCC (American Joint Committee on Cancer) 7th edition criteria. During the follow-up period, a lot of in-transit metastases appeared on the right leg. While we were resecting in-transit metastases, we concurrently started nivolumab in September 2018. After 17 cycles of nivolumab treatment, he developed severe nausea and anorexia. At baseline, his cortisol and adrenocorticotropic hormone levels were both at normal range, but corticotropin-releasing hormone loading test revealed secondary adrenal insufficiency. We diagnosed isolated adrenal insufficiency due to nivolumab. Treatment by hydrocortisone immediately relieved nausea and anorexia, and we could have continued treatment of nivolumab.
我们报告一例因纳武单抗导致的继发性肾上腺功能不全病例。一名83岁男性，右足底患有肢端雀斑样黑色素瘤，于2017年3月就诊于我院。他于2017年6月在转诊医院接受了原发灶手术，根据美国癌症联合委员会（AJCC）第7版标准，病理分期为IIIC期（pT3bN3M0）。在随访期间，右腿出现了许多皮下转移灶。在切除皮下转移灶时，我们于2018年9月同时开始使用纳武单抗治疗。在接受17个周期的纳武单抗治疗后，他出现了严重的恶心和厌食症状。基线时，他的皮质醇和促肾上腺皮质激素水平均在正常范围内，但促肾上腺皮质激素释放激素激发试验显示继发性肾上腺功能不全。我们诊断为因纳武单抗导致的孤立性肾上腺功能不全。氢化可的松治疗立即缓解了恶心和厌食症状，我们得以继续使用纳武单抗进行治疗。
