El Alam Andrew, Fleifel Mohamad, El Masri Dana, Nassani Bertha Maria, Abou Chaaya Jessica, Minkailou Mahamadou, Barbat Mariana, Monier Arnaud
Endocrinology and Metabolism Division Lebanese American University Medical Center, Beirut, Lebanon.
Endocrinology and Metabolism Division American University of Beirut Medical Center, Beirut, Lebanon.
Case Rep Endocrinol. 2024 Jul 10;2024:5444975. doi: 10.1155/2024/5444975. eCollection 2024.
Despite their important clinical benefits, immune checkpoint inhibitors (ICIs) are associated with a spectrum of side effects known as immune-related adverse events (irAEs). These can be of various organ system backgrounds, including dermatologic, pulmonary, gastrointestinal, and endocrine. Polyglandular endocrinopathies (PLEs) post-ICIs therapy has been reported in the literature; however, to our knowledge, only a few have been documented with pembrolizumab. . We present a case of a female patient who developed myxedema coma (MC) and adrenal insufficiency (AI) after 4 months of stopping pembrolizumab, a programed-cell death-1 inhibitor. The patient was clinically symptomatic and was subsequently treated with levothyroxine and hydrocortisone. . It is very important to be vigilant and alert in detecting MC and AI to avoid any mortality. Pembrolizumab's effect on inducing antitumor responses leads to a wide variety of multiorgan alterations. Its role in raising the risk of all-grade endocrine disorders has been previously highlighted along with thyroidal dysfunctions. Our patient's presentation falls within the literature-based median time for hypothyroidism and AI with respect to the period from the initiation of pembrolizumab. The patient's predisposition to hypothyroidism and the likelihood of intertwined manifestations of AI and hypothyroidism should always be considered in the setting of critical illness.
It is of high significance to explore the mechanism of action of ICIs and their side effects. PLEs can house some endocrinologic emergencies that are life threatening.
尽管免疫检查点抑制剂（ICIs）具有重要的临床益处，但它们与一系列被称为免疫相关不良事件（irAEs）的副作用相关。这些副作用可涉及各种器官系统，包括皮肤、肺部、胃肠道和内分泌系统。文献中已报道了ICI治疗后出现的多腺体内分泌病（PLEs）；然而，据我们所知，仅有少数使用帕博利珠单抗的病例有记录。我们报告一例女性患者，在停用程序性细胞死亡蛋白1抑制剂帕博利珠单抗4个月后发生黏液性水肿昏迷（MC）和肾上腺功能不全（AI）。该患者出现了临床症状，随后接受了左甲状腺素和氢化可的松治疗。在检测MC和AI时保持警惕非常重要，以避免任何死亡情况。帕博利珠单抗诱导抗肿瘤反应的作用会导致多种多器官改变。其在增加所有级别内分泌紊乱风险方面的作用，连同甲状腺功能障碍，此前已得到强调。就帕博利珠单抗开始使用后的时间段而言，我们患者的表现符合基于文献的甲状腺功能减退和AI的中位时间。在危重病情况下，应始终考虑患者发生甲状腺功能减退的易感性以及AI和甲状腺功能减退相互交织表现的可能性。
探索ICIs的作用机制及其副作用具有重要意义。PLEs可能包含一些危及生命的内分泌急症。
