内容紹介
Summary
Nivolumab induces several immune-related adverse events. Isolated adrenocorticotropic hormone(ACTH)deficiency has low frequency. A 73-year-old woman with gastric cancer metastasis of the peritoneum was treated with nivolumab as the third-line chemotherapy. After 5 courses of nivolumab, she developed hypothyroidism. After completing 12 courses, peritoneal metastasis increased. We evaluated the metastasis as progression of disease, so treatment with nivolumab was discontinued. Two weeks after the last dosage of nivolumab, she developed general fatigue and appetite loss. At first, we considered that these symptoms were caused by peritoneal metastasis, but progression was not indicated in the CT. Blood levels of cortisol and ACTH were very low. We suspected secondary adrenocortical insufficiency induced by nivolumab. Endocrinological examinations and the results of brain MRI suggested isolated ACTH deficiency. This is the first report of isolated ACTH deficiency induced by nivolumab in a patient with gastric cancer metastasis of the peritoneum. The symptoms of adrenocortical insufficiency induced by nivolumab overlap with those of peritoneal metastasis, and thus, it may be difficult to confirm a differential diagnosis. When adrenocortical insufficiency is suspected, we should check the blood levels of cortisol and ACTH.
要旨
ニボルマブによる免疫関連有害事象のなかでACTH単独欠損症はまれである。症例は73歳,女性。胃癌術後腹膜転移の三次治療としてニボルマブ治療が施行された。5コース投与後,甲状腺機能低下症を生じた。12コース終了後に病勢進行のためニボルマブを中止したが,2週間後より全身倦怠感と食欲不振が出現した。当初は腹膜転移の進行と考えたが,血中コルチゾール,ACTHが低値であったため,副腎機能不全の診断で精査を行いACTH単独欠損症と診断した。腹膜転移による症状と副腎機能不全の症状は重なる点があり,ニボルマブ治療歴のある患者では診断が遅れないよう留意すべきである。
目次
Nivolumab induces several immune-related adverse events. Isolated adrenocorticotropic hormone(ACTH)deficiency has low frequency. A 73-year-old woman with gastric cancer metastasis of the peritoneum was treated with nivolumab as the third-line chemotherapy. After 5 courses of nivolumab, she developed hypothyroidism. After completing 12 courses, peritoneal metastasis increased. We evaluated the metastasis as progression of disease, so treatment with nivolumab was discontinued. Two weeks after the last dosage of nivolumab, she developed general fatigue and appetite loss. At first, we considered that these symptoms were caused by peritoneal metastasis, but progression was not indicated in the CT. Blood levels of cortisol and ACTH were very low. We suspected secondary adrenocortical insufficiency induced by nivolumab. Endocrinological examinations and the results of brain MRI suggested isolated ACTH deficiency. This is the first report of isolated ACTH deficiency induced by nivolumab in a patient with gastric cancer metastasis of the peritoneum. The symptoms of adrenocortical insufficiency induced by nivolumab overlap with those of peritoneal metastasis, and thus, it may be difficult to confirm a differential diagnosis. When adrenocortical insufficiency is suspected, we should check the blood levels of cortisol and ACTH.
要旨
ニボルマブによる免疫関連有害事象のなかでACTH単独欠損症はまれである。症例は73歳,女性。胃癌術後腹膜転移の三次治療としてニボルマブ治療が施行された。5コース投与後,甲状腺機能低下症を生じた。12コース終了後に病勢進行のためニボルマブを中止したが,2週間後より全身倦怠感と食欲不振が出現した。当初は腹膜転移の進行と考えたが,血中コルチゾール,ACTHが低値であったため,副腎機能不全の診断で精査を行いACTH単独欠損症と診断した。腹膜転移による症状と副腎機能不全の症状は重なる点があり,ニボルマブ治療歴のある患者では診断が遅れないよう留意すべきである。