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Profound postinduction hypotension precipitated by immune checkpoint inhibitors: a case report
Lu Che1, Afang Zhu1, Wen Chen1
1Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, 100730, China.
Journal of Medical Case Reports
|March 8, 2024
Summary
Immune checkpoint inhibitors (ICIs) can cause hypothyroidism, a rare but serious side effect. Prompt diagnosis and thyroxine treatment are crucial for managing severe hypotension in patients undergoing surgery.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Increasing use of immune checkpoint inhibitors (ICIs) in cancer treatment necessitates awareness of potential immune-related adverse events (irAEs).
- Perioperative vigilance is crucial for identifying and managing irAEs that can complicate surgical recovery.
Observation:
- A patient with gastric cancer and Krukenberg tumors, treated with nivolumab, presented with severe hypotension prior to laparotomy.
- Hypotension persisted despite ruling out other common causes, prompting further investigation.
- The patient was diagnosed with severe hypothyroidism, identified as a likely irAE of nivolumab therapy.
Findings:
- Thyroxine replacement therapy effectively resolved the patient's severe hypotension.
- The patient experienced an uneventful recovery following surgical intervention and thyroid hormone replacement.
Implications:
- This case highlights the critical importance of considering irAEs, specifically hypothyroidism, in patients receiving ICIs.
- Prompt recognition and management of ICI-induced hypothyroidism are essential for optimizing perioperative outcomes in cancer patients.
