Department of Endocrinology and Metabolic Diseases, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Endocr Metab Immune Disord Drug Targets. 2023;23(7):996-1004. doi: 10.2174/1871530323666221208111823.
Immunotherapy-associated hypophysitis is an uncommon adverse event. However, if not handled properly, it could lead to fatal sequelae.
Case 1. A 66-year-old man presented to our hospital with hyponatremia. He had low plasma levels of adrenocorticotropin and cortisol. The patient had a history of non-small cell lung cancer and had undergone 16 cycles of immunotherapy with sintilimab, a monoclonal antibody against programmed cell death protein 1 (PD1). He was diagnosed with adrenal insufficiency secondary to immunotherapy-associated hypophysitis and received a physiological dose of glucocorticoids. Upon discharge, he has prescribed a continued course of hormone replacement therapy combined with immunotherapy.
CASE 2: The second case profiled here involved a 58- year-old patient diagnosed with gastric antrum cancer. After ten months of immunotherapy with carrelizumab, a human high-affinity immunoglobulin G4 (IgG4) anti-PD-1 monoclonal antibody drug, the patient was referred to the Endocrinology Department at our medical centre for adrenal nodules and intolerance of anorexia. He also suffered from hypophysitis and was prescribed hormone replacement therapy combined with immunotherapy.
This article discusses the clinical characteristics, diagnosis, treatment, and subsequent follow-up for immunotherapy-associated hypophysitis in the context of two case reports. Based on our findings and observations, we conclude that patients with immunotherapy should regularly be referred to endocrine-related follow-up during tumour treatment.
免疫治疗相关垂体炎是一种罕见的不良反应。然而，如果处理不当，可能会导致致命的后果。
病例 1，一名 66 岁男性因低钠血症就诊于我院。他的血浆促肾上腺皮质激素和皮质醇水平较低。该患者患有非小细胞肺癌病史，曾接受 16 个周期的免疫治疗，药物为替雷利珠单抗，一种针对程序性死亡蛋白 1（PD1）的单克隆抗体。他被诊断为免疫治疗相关垂体炎继发的肾上腺皮质功能不全，接受了生理剂量的糖皮质激素治疗。出院时，他被开具了激素替代治疗联合免疫治疗的医嘱。病例 2，这里介绍的第二例患者为 58 岁男性，诊断为胃窦癌。接受卡瑞利珠单抗（一种人源高亲和力 IgG4 抗 PD-1 单克隆抗体药物）免疫治疗十个月后，该患者因肾上腺结节和厌食不耐受被转诊至我院内分泌科。他还患有垂体炎，被开具了激素替代治疗联合免疫治疗的医嘱。
本文通过两例病例报告讨论了免疫治疗相关垂体炎的临床特征、诊断、治疗和后续随访。根据我们的发现和观察，我们得出结论，接受免疫治疗的患者在肿瘤治疗期间应定期转至内分泌相关的随访。
