信迪利单抗致甲状腺及肾上腺皮质功能减退

Hypothyroidism and adrenal cortex hypofunction caused by sintilimab

1例63岁男性肝细胞恶性肿瘤患者术后行信迪利单抗(200 mg静脉滴注、第1天,21 d为1个周期)免疫治疗,治疗3个周期后,患者出现口齿不清、精神萎靡、嗜睡、体重减轻。实验室检查示三碘甲状腺原氨酸(T3)0.54 nmol/L,甲状腺素(T4)13.0 nmol/L,促甲状腺激素(TSH)98.62 mU/L,游离三碘甲状腺原氨酸(FT3)0.43 pmol/L,游离甲状腺素(FT4)0.25 pmol/L,皮质醇(Cor)(8:00)6.1 nmol/L,促肾上腺皮质激素(ACTH)(8:00)0.22 pmol/L,诊断为信迪利单抗所致免疫相关性甲状腺功能减退症、肾上腺皮质功能减退症。给予糖皮质激素治疗4 d后,患者上述症状缓解,给予左甲状腺素口服,糖皮质激素逐渐减量。左甲状腺素治疗11 d后,实验室检查结果提示甲状腺功能恢复正常,停用左甲状腺素;肾上腺皮质功能指标Cor(8:00)51.6 nmol/L,ACTH(8:00)0.22 pmol/L,继续口服醋酸泼尼松片5 mg、1次/d。随访8个月,患者肾上腺皮质功能持续低下,未再启用信迪利单抗治疗。

A 63‑year‑old male patient with hepatocellular carcinoma received sintilimab(200 mg by IV infusion on day 1,21 days as one cycle)after surgery.After 3 cycles of treatment,the patient developed unclear speech,mental fatigue,drowsiness,and weight loss.Laboratory tests showed triiodothyronine(T3)0.54 nmol/L,thyroxine(T4)13.0 nmol/L,thyroid‑stimulating hormone(TSH)98.62 mU/L,free triiodothyronine(FT3)0.43 pmol/ml,free thyroxine(FT4)0.25 pmol/L,cortisol(Cor)(8:00)6.1 nmol/L,adrenocorticotropic hormone(ACTH)(8:00)0.22 pmol/L/L.He was diagnosed as having immune‑related hypothyroidism and adrenal cortex hypofunction,which was caused by sintilimab.After 4 days of treatments with glucocorticoid,the above symptoms in the patient were improved,and levothyroxine was given.The dosage of glucocorticoids given to patients was gradually reduced.After 11 days of treatments with levothyroxine,the laboratory tests showed that the thyroid function returned to normal,and levothyroxine was stopped.Adrenal cortex function was still lower than normal[Cor(8:00)51.6 nmol/L,ACTH(8:00)0.22 pmol/L].Then prednisone acetate tablets 5 mg once daily orally were given continuously.At 8 months of follow‑up,the adrenal cortex function in the patient remained low,and sintilimab was stopped forever.