免疫检查点抑制剂诱导的低细胞性炎:一种特定的皮质营养菌疾病?
Nishchil Patel1, Kagabo Hirwa1, Gemma Gardner1
1Department of Endocrinology, University Hospital Plymouth, UK.
Endocrine connections
|September 30, 2024
概括
免疫检查点抑制剂治疗可能会导致永久性垂体损伤,特别是影响皮质醇的产生. 这种与免疫相关的低性炎会导致患者的长期上腺功能不充分.
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) 越来越多地用于癌症治疗.
- 不良的内分泌事件,包括垂体功能障碍,是已知的ICI的副作用.
- 了解ICI诱导的下垂体疾病的频谱和长期后果至关重要.
研究的目的:
- 定义ICI治疗后的功能性和解剖性垂体疾病.
- 在接受ICI治疗的患者中,随着时间的推移描述垂体功能的变化.
- 描述与免疫媒介性低体质炎相关的成像发现.
主要方法:
- 对接受ICI治疗的患者进行回顾性观察审计.
- 纳入标准:怀疑上腺功能不全,并有脑垂体疾病的证据,转诊内分泌学.
- 研究人员审查了垂体功能测试和垂体成像.
主要成果:
- 在接受ICI治疗的患者中,3.9%的患者出现了下丘脑-垂体-上腺轴功能障碍.
- 症状发作的中位数为4个月;没有观察到皮质醇或ACTH水平的恢复.
- 在7/27患者中观察到特定的MRI异常 (前垂体纹),与皮质otroph功能障碍相关.
结论:
- 免疫相关的低血清炎是ICI治疗的常见并发症.
- 这种功能障碍似乎特别针对皮质营养细胞,导致永久的ACTH和皮质醇缺乏.
- 图像异常可能是短暂的,并且特定于前垂体腺.
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