信迪利单抗致免疫相关肾上腺皮质功能减退1例

One case of immune-related adrenocortical dysfunction induced by sintilimab

1例29岁男性患者,因“右半结肠癌姑息术后1年,拟治疗”于2020年3月入院进一步诊治,3月27日使用信迪利单抗(200 mg,q 3 w,ivgtt)联合化疗,治疗8个月后患者出现明显乏力,体重1个月内下降5 kg,鉴于患者为青壮年且前期营养状态评估一直良好,考虑为免疫相关性内分泌系统不良事件,检查相关激素示:皮质醇0.104μg·dL^(-1)(08:00),促肾上腺皮质激素2.160 pg·mL^(-1)(08:00),皮质醇0.019μg·dL^(-1)(16:00),促肾上腺皮质激素1.649 pg·mL^(-1)(16:00),诊断为继发性肾上腺皮质功能减退症。遂立即停用信迪利单抗并给予营养支持,经停药一周期后患者营养状况好转,体重上升,乏力感消失。

A 29-year-old male patient was hospitalized in March 2020 for further diagnosis and treatment because of one year after palliative surgery for right colon cancer.On March 27th,sintilimab(200 mg,q 3 w,ivgtt)combined with chemotherapy was given to him.Eight months later,he developed obvious fatigue and his body weight decreased by 5 kg within one month.In view of the fact that he was a young adult and was in good nutrition status before,it was considered to be an immune-related adverse event of the endocrine system.The examination of relevant hormones showed that cortisol was 0.104μg·dL^(-1) at 08:00,adrenocorticotropic hormone was 2.160 pg·mL^(-1) at 08:00,cortisol was 0.019μg·dL^(-1) at 16:00,adrenocorticotropic hormone was 1.649 pg·mL^(-1) at 16:00,based on which he was diagnosed with secondary adrenocortical dysfunction.Sintilimab was stopped immediately and nutritional support treatment was given to him.After one cycle of withdrawal,the patient's nutritional status improved,the body weight increased and the fatigue disappeared.