PDF(Pubmed)
Abstract：
With advancements in medical oncology, immune checkpoint inhibitors (ICIs) have become the first-line treatment for many malignancies. ICIs play a significant role in improving cancer prognosis, but a series of immune-related adverse events (irAEs), including immune-related endocrine events (irEEs), caused by ICIs have also aroused concerns. Rapid clinical identification of irAEs caused by ICIs is particularly important. We describe a case of secondary adrenocortical insufficiency (AI) after PD-1 treatment in a postoperative patient with endometrial cancer. A 73-year-old female patient developed anorexia, nausea, vomiting, malaise, electrolyte disturbances, ineffective symptomatic treatment, and decreased serum adrenocorticotropin and cortisol levels six months after retifanlimab treatment. The vomiting resolved, and the electrolyte levels were corrected after 3 days of treatment with glucocorticoids (hydrocortisone, intravenous, 200 mg/day). When patients present with gastrointestinal symptoms, such as poor appetite and nausea, not only symptomatic treatment but also a search for the etiology behind the symptoms is needed, especially in immunotherapy patients who should undergo a thorough evaluation of the endocrine system and be alert for adrenocortical insufficiency.
摘要：
随着医学肿瘤学的进步，免疫检查点抑制剂(ICIs)已成为许多恶性肿瘤的一线治疗方法.ICI在改善癌症预后方面发挥着重要作用，但一系列免疫相关的不良事件（irAE），包括与免疫相关的内分泌事件（IREEs），由ICI引起的关注也引起了人们的关注。由ICIs引起的irAE的快速临床鉴定尤为重要。我们描述了子宫内膜癌术后患者PD-1治疗后继发性肾上腺皮质功能不全（AI）的情况。一名73岁的女性患者出现厌食症，恶心,呕吐,萎靡不振,电解质干扰，无效的对症治疗，retifanlimab治疗6个月后血清促肾上腺皮质激素和皮质醇水平下降。呕吐消失了,和电解质水平在糖皮质激素治疗3天后得到纠正(氢化可的松，静脉注射,200毫克/天）。当患者出现胃肠道症状时，比如食欲不振和恶心，不仅需要对症治疗，还需要寻找症状背后的病因，特别是在免疫治疗患者中，应该对内分泌系统进行彻底评估，并警惕肾上腺皮质功能不全。
