PD-1 Inhibitors Induced Primary Hypoadrenalism
نویسندگان
چکیده
Abstract Background: Primary adrenal insufficiency is known to be induced by certain medications, including anesthetics, antimycotic and antiparasitic medications. However, it rarely being reported that caused antitumor immune checkpoint inhibitors PD-1. Clinical Case: A 82-year-old female with a significant history of lung adenocarcinoma status post recent Pembrolizumab therapy. She presented multiple complaints, increasing confusion, mainly memory loss, generalized aches, pains who was found have recurrent hyponatremia sodium level 122, treated water restriction tablets. Initial screening labs were suggestive insufficiency: ACTH within the normal range (11 pg/dL, 7.2–63 pg/dL), cortisol low (1.6 ng/dL, 3–23 pg/dL). MRI brain without contrast ruled out metastatic disease. An ACTH-stimulating test performed, results revealing an inadequate response at 0, 30, 60 minutes(1.4 ug/gl, 8.5 ug/dl, 11.9 18–20 ug/gl). Therefore, diagnosis primary made. The patient prescribed daily oral dose 5 mg hydrocortisone. Her symptoms improved after few days, her hydrocortisone gradually increased 15 daily, energy back baseline six months. Conclusion: This rare case using for non-small cancer treatment. With growing use Pembrolizumab, necessary aware possible could associated receiving pembrolizumab therapy amid any clinical suspicion. Reference: Chang, L.S., et al., Endocrine Toxicity Cancer Immunotherapy Targeting Immune Checkpoints. Endocr, Rev, 2019. 40(1): p. 17–65
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ژورنال
عنوان ژورنال: Journal of the Endocrine Society
سال: 2021
ISSN: ['2472-1972']
DOI: https://doi.org/10.1210/jendso/bvab048.296