Cheng Nina H, Lee Hannah, Balchander Divya, Mimms Remy, Krishnamurthy Mahesh
Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Endocrinology, St. Luke's Hospital, Monroe, PA, USA.
J Community Hosp Intern Med Perspect. 2024 Jul 2;14(4):68-70. doi: 10.55729/2000-9666.1375. eCollection 2024.
Endocrinopathies following immunotherapy have infrequently been documented in the literature. Adrenal insufficiency is a rare consequence of pembrolizumab immunotherapy, with incidence reported to be between 0.98 and 1.3%. We present the case of a 34-year-old female with triple negative breast cancer on chemotherapy who presented with generalized weakness with tachycardia, tachypnea and hypotension unresponsive to fluids. Despite initial improvement with intravenous hydrocortisone and midodrine, the patient continued to be symptomatically hypotensive following discharge and required re-admission. AM cortisol level was found to be < 0.5 ug/dl and ACTH was <1.5 pg/dL, consistent with secondary adrenal insufficiency. CT abdomen and pelvis was unremarkable for adrenal pathology. Patient had been initiated on pembrolizumab (Keytruda) 4 months prior to presentation as part of neoadjuvant chemotherapy. The patient was provided supportive treatment with discharge on fludrocortisone, prednisone, and midodrine. This case reports an unusual consequence of immune checkpoint inhibitors, in which early diagnostic testing, identification, and management is critical.
免疫治疗后内分泌病在文献中的记载较少。肾上腺功能不全是帕博利珠单抗免疫治疗的罕见后果，据报道其发生率在0.98%至1.3%之间。我们报告了一例34岁三阴性乳腺癌女性患者，她正在接受化疗，出现全身无力，伴有心动过速、呼吸急促和低血压，对补液无反应。尽管静脉注射氢化可的松和米多君后最初有所改善，但患者出院后仍有症状性低血压，需要再次入院。发现上午皮质醇水平<0.5μg/dl，促肾上腺皮质激素<1.5pg/dL，符合继发性肾上腺功能不全。腹部和盆腔CT未发现肾上腺病变。患者在就诊前4个月开始使用帕博利珠单抗（可瑞达）作为新辅助化疗的一部分。患者出院时接受了氟氢可的松、泼尼松和米多君的支持治疗。本病例报告了免疫检查点抑制剂的一种不寻常后果，其中早期诊断检测、识别和管理至关重要。
