Finsterer Josef
Neurology & Neurophysiology Center Vienna Austria.
Clin Case Rep. 2025 Jan 29;13(2):e9399. doi: 10.1002/ccr3.9399. eCollection 2025 Feb.
Pembrolizumab is a monoclonal antibody directed against the programmed cell death-1 (PD1) receptor, which binds to PD1 receptors on T lymphocytes and blocks their inactivation by tumor cells. Pembrolizumab is not free from side effects, a rare one of which is hypocorticism. Here we present a patient with pembrolizumab-induced hypocorticism manifested by a cerebrovascular event. The patient is a 67-year-old male with a history of urothelial carcinoma of the left kidney and urothelial carcinoma of the urinary bladder. These malignancies were treated with resection and adjuvant chemotherapy. Pembrolizumab was added 6 months before admission. After the fifth cycle, he suffered loss of appetite, persistent nausea and recurrent vomiting, an itchy rash, expressive aphasia for a few seconds during which he was suddenly unable to pronounce words and sentences, and massive positional vertigo due to arterial hypotension. His serum cortisol level was significantly low. Hypocorticism was successfully treated with hydrocortisone. This case demonstrates that pembrolizumab can be complicated by hypocorticism even after uneventful previous administration and that hypocorticism can manifest with symptomatic arterial hypotension, cerebral hypoperfusion, and positional vertigo. Treating physicians should be aware that secondary hypocorticism is a potentially serious adverse reaction due to the cumulative toxicity of pembrolizumab.
帕博利珠单抗是一种针对程序性细胞死亡蛋白 1（PD1）受体的单克隆抗体，它与 T 淋巴细胞上的 PD1 受体结合，阻止肿瘤细胞使其失活。帕博利珠单抗并非没有副作用，其中一种罕见的副作用是肾上腺皮质功能减退。在此，我们报告一例因帕博利珠单抗导致肾上腺皮质功能减退并表现为脑血管事件的患者。该患者为 67 岁男性，有左肾尿路上皮癌和膀胱尿路上皮癌病史。这些恶性肿瘤接受了手术切除和辅助化疗。入院前 6 个月开始使用帕博利珠单抗。在第五个疗程后，他出现食欲减退、持续性恶心和反复呕吐、瘙痒性皮疹、数秒的表达性失语（期间突然无法说出单词和句子）以及因动脉低血压导致的大量体位性眩晕。他的血清皮质醇水平显著降低。肾上腺皮质功能减退通过氢化可的松成功治疗。该病例表明，即使之前用药过程平稳，帕博利珠单抗也可能并发肾上腺皮质功能减退，且肾上腺皮质功能减退可表现为症状性动脉低血压、脑灌注不足和体位性眩晕。治疗医生应意识到，由于帕博利珠单抗的累积毒性，继发性肾上腺皮质功能减退是一种潜在的严重不良反应。
