超越瘤:免疫疗法的内分泌陷
Cho May Than1, Kyaw Maung Maung2, Ye Win2
1Acute Medicine, United Lincolnshire Teaching Hospital Trust, Boston, GBR.
Cureus
|October 10, 2025
概括
免疫检查点抑制剂 (ICI) 可以导致上腺功能不充分,这是一个严重的副作用. 早期检测和内分泌管理对于接受ICI (如黑色素瘤布罗利祖马布) 的患者至关重要.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 内分泌学 在内分泌学.
背景情况:
- 免疫检查点抑制剂 (ICI) 如 pembrolizumab 对晚期黑色素瘤有效.
- ICI可以引起与免疫相关的不良事件 (irAEs),包括内分泌功能障碍.
- 上腺功能不充分是与ICI相关的潜在危及生命的irAE.
研究的目的:
- 在患有黑色素瘤的患者中报告由 pembrolizumab 诱导的二次上腺功能衰竭病例.
- 突出ICI诱导上腺功能不充分的非特异性症状和诊断挑战.
- 强调警监测和早期内分泌咨询的重要性.
主要方法:
- 一个62岁的女性患有第三期BRAF阴性黑色素瘤的病例报告.
- 辅助 pembrolizumab 治疗进行.
- 通过生物化学评估 (低皮质醇,无法检测到的ACTH) 确认了二次上腺功能不足的诊断.
主要成果:
- 患者在三次 pembrolizumab 循环后出现了二次上腺功能衰竭.
- 症状包括胃肠道困扰和全身炎症.
- 她的临床状况稳定,正在接受皮替代疗法.
结论:
- 由 pembrolizumab 诱导的上腺功能不全可以潜伏地表现为非特异性症状.
- 及时进行生化评估是必要的,以避免误诊.
- 警irAEs和及时的内分泌管理对于患者的结果至关重要.
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