1例75岁女性胃癌患者接受卡度尼利单抗(500 mg，ivd，d1)+白蛋白结合型紫杉醇(300 mg，ivd，d1)+替吉奥(40 mg，po，bid，d2～15)治疗，21 d 为1个周期。4周期治疗结束后入院检查，提示促肾上腺皮质激素＜1。00pg·mL-1，血皮质醇0。42 μg·dL-1，血钠131 mmol·L-1，考虑为免疫检查点抑制剂相关垂体炎，入院第4天突发垂体危象，考虑为卡度尼利单抗所致，予以大剂量糖皮质激素口服、补液、纠正电解质紊乱等治疗后，第9天患者垂体危象基本缓解。卡度尼利单抗致垂体危象在临床中较为罕见，提示临床如患者在用药期间出现乏力、纳差、低钠血症等情况，应警惕药物相关垂体炎的可能性，评估内分泌腺体功能，从而及时采取治疗，对改善患者预后具有重要临床意义。
A case of pituitary crisis caused by cadonilimab treatment of advanced gastric cancer
A 75-year-old female patient with gastric cancer received cadonilimab(500 mg,iv,d1)combined with albumin-bound paclitaxel(300 mg,iv,d2)and tegafur,gimeracil and oteracil potassium(40 mg,po,bid,d2-15)and 21 days was a cycle.Admission examination at the end of 4 cycles of treatment,laboratory tests showed adrenocorticotropic hormone＜1.00 pg,mL-1,cortisol 0.42 μg·dL-1 and serum sodium 131 mmol·L-1.Immune checkpoint inhibitor-related hypophysitis was diagnosed,and pituitary crisis was developed on the 4th day.The diagnosis of hypophysitis concurrent with pituitary crisis was considered to be related to cadonilimab.High-dose glucocorticoids replacement and symptomatic treatment such as rehydration to maintain electrolyte imbalance were given.On the 9th day after admission,the patient was basically in remission.The administration of cadonilimab may cause pituitary crisis,which is relatively rare in clinical practice.This case reminds that the possibility of hypophysitis when patients emerge with the symptom of fatigue and anorexia along with hyponatremia.Assessment of endocrine gland function,correct diagnosis and proper therapy are of significant clinical value to improve the patients'prognosis.
CadonilimabPituitary crisisImmune-related adverse eventAdverse drug reaction
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维普
