Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Japan.
Intern Med. 2023 Nov 15;62(22):3341-3346. doi: 10.2169/internalmedicine.1446-22. Epub 2023 Apr 7.
Atezolizumab and bevacizumab are currently available as first-line treatments for unresectable hepatocellular carcinoma, but immune-related adverse events are a major concern. We herein report two cases of isolated adrenocorticotropic hormone (ACTH) deficiency. Both patients presented with general fatigue, appetite loss, eosinophilia, and hyponatremia after nine cycles in case 1 and three months after stopping treatment for inflammatory arthritis in case 2. Endocrinological investigations revealed unsatisfactory ACTH and cortisol responses despite the preservation of other anterior pituitary hormones, suggesting isolated ACTH deficiency. As it is rapidly improved by steroid replacement therapy, an early diagnosis and treatment make it possible to resume immunotherapy.
阿替利珠单抗和贝伐珠单抗目前可用作不可切除肝细胞癌的一线治疗药物，但免疫相关不良反应是一个主要关注点。我们在此报告两例孤立性促肾上腺皮质激素（ACTH）缺乏症病例。在病例 1 中，患者在接受了九轮治疗后出现全身乏力、食欲减退、嗜酸性粒细胞增多和低钠血症，而在病例 2 中，患者在停止治疗炎症性关节炎三个月后出现这些症状。尽管其他垂体前叶激素仍存在，但内分泌学检查显示 ACTH 和皮质醇反应不佳，提示孤立性 ACTH 缺乏症。由于其通过类固醇替代治疗可迅速改善，因此早期诊断和治疗可使其恢复免疫治疗。
