诊断免疫疗法诱导的下丘脑-垂体-上腺轴异常的潜在陷:一个临床案例
Yixi Bi1, Safwaan Adam1, Viktoria Chatzimavridou1
1The Christie's NHS Foundation Trust, Manchester, UK.
Endocrine oncology (Bristol, England)
|July 12, 2023
概括
在接受免疫治疗的患者中,短时间的突触测试可能会错过早期的腺上皮质激素激素 (ACTH) 缺乏. 当临床怀疑低皮质醇血症尽管初始结果正常,但仍然存在时,使用不同的测定重复测试至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 越来越多地用于转移性黑色素瘤.
- ICI治疗可能导致内分泌病变,包括低皮质素血症.
- 在接受免疫治疗的患者中评估ACTH缺乏症需要仔细考虑诊断测试的限制.
研究的目的:
- 在接受ICI治疗的患者中,提出ACTH缺乏症延迟诊断的情况.
- 突出短期突触测试 (SST) 在检测早期二次上腺功能缺陷方面的潜在陷.
- 强调在临床怀疑较高时考虑替代诊断方法的重要性.
主要方法:
- 一个53岁的男性患有转移性黑色素瘤,正在接受ICI治疗的病例报告.
- 使用重复的短 синаcthen 测试 (SSTs) 和 ACTH 测试进行低皮质隔离血的调查.
- 从局部ACTH测量和替代测试结果的比较.
主要成果:
- 最初的SST正常,尽管有临床怀疑的低皮质醇血症.
- 使用局部检测测量的ACTH测量是不确定的.
- 重复ACTH测试用另一种测试证实了ACTH缺乏.
- 患者在临床和生化证据上发现了ACTH缺乏,尽管最初的测试结果正常.
结论:
- 短时间的突触测试可以在早期的二次上腺功能不足中产生错误的负结果,这是由于剩余的上腺储备.
- 临床表现和生化发现之间的差异需要使用不同的试验重复ACTH测试.
- 临床医生必须保持对ICI诱导内分泌病变的高度怀疑指数,并意识到诊断测试的局限性.
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