Ozawa Yuka, Tokito Takaaki, Kikuchi Mariko, Katoh Hiroshi, Sangai Takafumi
Breast and Thyroid Surgery, Kitasato University Hospital, Sagamihara, JPN.
Cureus. 2025 Feb 6;17(2):e78620. doi: 10.7759/cureus.78620. eCollection 2025 Feb.
We report two cases of adrenal insufficiency (AI) occurring during neoadjuvant treatment with pembrolizumab for breast cancer. In the first case, a 53-year-old female presented with a chief complaint of poor oral intake and fatigue. In the second case, a 46-year-old female presented with a chief complaint of fever, poor oral intake, and general fatigue and was admitted with a diagnosis of pneumonia. Her symptoms did not improve during treatment for pneumonia. After that, two patients were diagnosed with pembrolizumab-induced adrenal insufficiency and were treated with hydrocortisone with improvement in their symptoms. AI due to pembrolizumab use is a relatively rare adverse event, but if it is detected late, it can be potentially life-threatening. In both cases, there were clear changes in the common terminology criteria for adverse events (CTCAE) grade at the time of diagnosis of AI. It may be useful for early detection of AI. The CTCAE version 5.0 was used to assess the severity of adverse events.
我们报告了两例在使用帕博利珠单抗进行乳腺癌新辅助治疗期间发生肾上腺功能不全（AI）的病例。第一例，一名53岁女性，主要症状为食欲减退和疲劳。第二例，一名46岁女性，主要症状为发热、食欲减退和全身疲劳，因肺炎入院。在肺炎治疗期间，她的症状没有改善。之后，两名患者被诊断为帕博利珠单抗诱导的肾上腺功能不全，并接受氢化可的松治疗，症状有所改善。使用帕博利珠单抗导致的AI是一种相对罕见的不良事件，但如果发现较晚，可能会危及生命。在这两例中，诊断AI时不良事件通用术语标准（CTCAE）分级均有明显变化。这可能有助于AI的早期检测。使用CTCAE第5.0版评估不良事件的严重程度。
