Rossi Silvia, Silvetti Francesca, Bordoni Monia, Ciarloni Alessandro, Salvio Gianmaria, Balercia Giancarlo
Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona 60126, Italy.
JCEM Case Rep. 2024 Nov 4;2(11):luae200. doi: 10.1210/jcemcr/luae200. eCollection 2024 Nov.
Immune checkpoint inhibitor drugs can trigger autoimmune endocrine reactions as a known side effect. Several cases of immunotherapy-induced autoimmune endocrinopathies have been described, but multiple sequential endocrine toxicities are a rare occurrence. A 39-year-old patient with metastatic melanoma started adjuvant therapy with pembrolizumab. One month later he presented with asymptomatic thyrotoxicosis and, within several weeks, overt hypothyroidism, for which he started levothyroxine therapy. Subsequently the patient developed central adrenal insufficiency due to probable hypophysitis, and steroid replacement therapy was started. Pembrolizumab therapy was then discontinued. After a few months, a full recovery of pituitary function was observed, but primary adrenal insufficiency occurred, requiring additional fludrocortisone therapy. The described clinical case is a very uncommon case of triple endocrinological toxicity from immunotherapy. The clinical and biochemical manifestations of immunotherapy-induced endocrinopathies can be variable and atypical; therefore, it is necessary to pay special attention to any clue of hormonal dysfunction.
免疫检查点抑制剂药物可引发自身免疫性内分泌反应，这是一种已知的副作用。已有多例免疫治疗引起的自身免疫性内分泌病的病例报道，但多种连续的内分泌毒性较为罕见。一名39岁的转移性黑色素瘤患者开始接受帕博利珠单抗辅助治疗。一个月后，他出现无症状甲状腺毒症，几周内发展为明显的甲状腺功能减退，为此他开始接受左甲状腺素治疗。随后，患者因可能的垂体炎出现中枢性肾上腺功能不全，并开始接受类固醇替代治疗。随后停用了帕博利珠单抗治疗。几个月后，观察到垂体功能完全恢复，但出现了原发性肾上腺功能不全，需要额外的氟氢可的松治疗。所描述的临床病例是免疫治疗导致三重内分泌毒性的非常罕见的病例。免疫治疗引起的内分泌病的临床和生化表现可能多种多样且不典型；因此，有必要特别关注任何激素功能障碍的线索。
