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A Case of Transient ACTH and Cortisol Suppression Caused by Dexamethasone Mouthwash during Immune Checkpoint
Yosuke Aoyama1, Yurie Haruyama1, Yukinori Ozaki1
1Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan.
Abstract:
Immune checkpoint inhibitors (ICIs) can cause endocrine adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report a case of transient ACTH and cortisol suppression mimicking ICI-induced IAD during pembrolizumab therapy for metastatic triple-negative breast cancer. A 59-year-old woman developed low ACTH and cortisol levels while receiving pembrolizumab in combination with nab-paclitaxel. ICI-related IAD was initially suspected. However, her hormone levels normalized after the discontinuation of dexamethasone mouthwash used for oral mucositis. These findings suggest the transient suppression of the hypothalamic-pituitary-adrenal axis due to exogenous steroid exposure. Clinicians should consider steroid-containing mouthwashes as a potential cause of adrenal axis suppression during ICI therapy.
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