PD‑1抑制剂新辅助治疗致围术期中枢性肾上腺功能不全2例并文献复习

Two cases of central adrenal insufficiency caused by neoadjuvant therapy with PD-1 inhibitors during the perioperative period

目的通过分析2例PD-1抑制剂不良反应病例,帮助临床医师和药师在围术期及时发现和正确处理免疫治疗相关不良反应,保障患者的用药安全。方法针对2例围术期发生免疫治疗相关中枢性肾上腺功能不全的病例,对其治疗情况进行分析,并进行文献检索,探究免疫治疗诱发垂体炎概况及应对方法。结果经过分析发现,2例患者在围术期出现的中枢性肾上腺功能不全考虑为既往接受PD-1抑制剂治疗诱发的免疫相关垂体炎,具体表现为促肾上腺皮质激素的缺乏伴严重的低钠血症,给予糖皮质激素替代治疗后,相关症状缓解,但肾上腺功能不全没有恢复。结论对于接受过PD-1抑制剂新辅助治疗的患者,在围术期应定期监测垂体相关激素水平,警惕围术期发生的垂体免疫相关不良反应,及时治疗,避免临床急症的发生。

Objective To help clinicians and pharmacists discover and handle immunotherapy-related adverse reactions promptly and correctly during the perioperative period by reporting 2 cases of adverse drug reactions of PD-1 inhibitors,so as to ensure patient medication safety.Methods The treatment for 2 cases of immunotherapy-related central adrenal insufficiency in the perioperative period was analyzed and literature search was conducted to explore the overview of hypophysitis induced by immunotherapy and the coping methods.Results It was found that the central adrenal insufficiency in 2 patients during the perioperative period was considered as immune-related hypophysitis induced by PD-1 inhibitors.The specific manifestation was adrenocorticotropic hormone deficiency accompanied by severe hyponatremia.After receiving glucocorticoid replacement therapy,the related symptoms were relieved,but the adrenal insufficiency was not recovered.Conclusion For patients who have received neoadjuvant therapy with PD-1 inhibitors,pituitary-related hormone levels should be monitored regularly during the perioperative period.Pituitary immune-related adverse reactions during the perioperative period should be alerted to and treated promptly to avoid the occurrence of clinical emergencies.