PD-1抑制剂内分泌不良事件
ENGLISH ABSTRACT
一例PD-1抑制剂相关垂体炎的诊治
王林杰
袁涛
段炼
阳洪波
潘慧
朱惠娟
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1000-6699.2019.07.003
Diagnosis and treatment of one case of hypophysitis caused by PD-1 inhibitor
Wang Linjie
Yuan Tao
Duan Lian
Yang Hongbo
Pan Hui
Zhu Huijuan
Authors Info & Affiliations
Wang Linjie
Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, The Translational Medicine Center of PUMCH, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Yuan Tao
Duan Lian
Yang Hongbo
Pan Hui
Zhu Huijuan
·
DOI: 10.3760/cma.j.issn.1000-6699.2019.07.003
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摘要

本文报道1例由程序性死亡受体1(programmed death-1,PD-1)抑制剂导致的垂体炎。该患者为59岁女性,因转移性恶性黑色素瘤参加PD-1抑制剂特瑞普利单抗Ⅱ期临床试验,用药5个月余出现乏力、精神萎靡、恶心、纳差;实验室检查提示轻度低钠血症、继发性肾上腺皮质功能减退症及继发性甲状腺功能减退症;鞍区MRI提示垂体增大伴明显强化。诊断为PD-1抑制剂导致的垂体炎,予糖皮质激素及左旋甲状腺素钠生理替代治疗,患者临床症状改善。替代治疗8周后复查MRI,可见垂体大小恢复正常;此后每3个月复查垂体MRI,均提示垂体大小稳定。在接受PD-1抑制剂治疗中的患者,若出现乏力、纳差等情况,需警惕药物相关垂体炎的可能性,及时发现、采用正确的治疗措施及规律的随诊对保证患者安全、改善预后具有重要的临床意义。

程序性死亡受体1抑制剂;垂体炎
ABSTRACT

We reported a case of hypophysitis caused by a programmed death-1(PD-1)inhibitor. The patient was a 59-year-old female with metastatic malignant melanoma who participated in the phase Ⅱ clinical trial of a PD-1 inhibitor toripalimab. More than five months after the administration of toripalimab, she experienced fatigue, depression, nausea, and anorexia. Laboratory examinations showed mild hyponatremia, secondary adrenal insufficiency, and secondary hypothyroidism. MRI revealed the enlargement of her pituitary with obvious enhancement. The patient was diagnosed as hypophysitis caused by the PD-1 inhibitor and was given replacement therapy with physiological doses of corticosteroid and levothyroxine sodium. Her symptoms were then improved. MRI revealed that her pituitary size returned to normal after 8 weeks of treatment and remained stable during every 3-month follow-up. This case reminds us of the possibility of hypophysitis when patients suffere from fatigue and anorexia during the process of PD-1 inhibitor treatment. Correct diagnosis, proper therapy, and regular follow-up are important to ensure the patients′ safety, and to improve their prognosis.

Programmed death-1 inhibitor;Hypophysitis
Zhu Huijuan, Email: mocdef.3ab614002nixgnehS
引用本文

王林杰,袁涛,段炼,等. 一例PD-1抑制剂相关垂体炎的诊治[J]. 中华内分泌代谢杂志,2019,35(7):554-558.

DOI:10.3760/cma.j.issn.1000-6699.2019.07.003

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免疫检查点(immune checkpoint)是免疫系统中的保护分子,起类似刹车作用,以防止T淋巴细胞过度激活导致正常组织损伤和破坏。但是肿瘤细胞却能够利用免疫系统这一特性,通过过度表达免疫检查点分子或其配体,抑制体内免疫系统反应,逃避免疫监视与杀伤。新型抗肿瘤药物免疫检查点抑制剂(immune checkpoint inhibitors,ICPis)则通过拮抗免疫检查点蛋白,促进T淋巴细胞活化,进而产生抗肿瘤免疫效应。ICPis的出现被认为是近些年来肿瘤治疗领域的里程碑,目前已上市的药物包括细胞毒性T淋巴细胞相关抗原4(cytotoxic T lymphocyte associated antigen-4,CTLA-4)抗体、程序性死亡受体1(programmed death-1,PD-1)抗体及程序性死亡受体配体1(programmed death ligand-1,PD-L1)抗体三种类型,主要用于恶性黑色素瘤、非小细胞肺癌、肾细胞癌、胃癌、结直肠癌等多种实体及血液系统肿瘤的治疗,并显示出良好的疗效。但正是由于ICPis可能造成体内的T淋巴细胞过度激活,故此类药物应用时会带来其特有的不良反应,即免疫相关不良事件(immune-related adverse events,irAEs),可导致患者出现乏力、关节痛、肌肉痛等全身非特异性症状及器官特异性受累表现,其中irAEs主要受累的内分泌腺体包括垂体、甲状腺、胰腺及肾上腺,患者可出现垂体炎、甲状腺炎、糖尿病、原发性肾上腺皮质功能减退等表现 [ 1 , 2 ]。当患者出现垂体炎时,常伴随垂体功能减退、甚至垂体危象的可能,若不及时识别,严重者可危及生命。本文介绍1例转移性恶性黑色素瘤患者应用PD-1抑制剂过程中出现垂体炎的诊治、随访情况,以期提高内分泌科医师对于免疫检查点抑制剂应用过程中出现垂体炎的认识。
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备注信息
A
朱惠娟,Email: mocdef.3ab614002nixgnehS
B
所有作者均声明不存在利益冲突
C
中国医学科学院医学与健康科技创新工程项目 (2016-I2M-1-002,2017-I2M-1-011)
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