A Case of Acute Adrenal Insufficiency Unmasked During Sunitinib Treatment for Metastatic Renal Cell Carcinoma
A Case of Acute Adrenal Insufficiency Unmasked During Sunitinib Treatment for Metastatic Renal Cell Carcinoma
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DOI：
10.1093/jjco/hys070
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发表时间：
2012-08-01
影响因子：
2.4
通讯作者：
Nishiyama, Hiroyuki
中科院分区：
文献类型：
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作者：
Yoshino, Takayuki;Kawai, Koji;Nishiyama, Hiroyuki
舒尼替尼最近已成为转移性肾细胞癌的标准治疗。然而，已报告了各种不良事件。我们提出了第一例临床上明显的肾上腺皮质功能不全舒尼替尼治疗。一名72岁的男性开始舒尼替尼治疗肾细胞癌的双侧肺和肾上腺转移。舒尼替尼治疗前，他的促肾上腺皮质激素水平为93.6 pg/ml（7.263.3 pg/ml），表明已经存在亚临床肾上腺功能不全。疲劳是舒尼替尼治疗的常见不良反应，在第二个周期的第24天急性出现。促肾上腺皮质激素和游离T4较高，促甲状腺激素受到抑制。在临床诊断为急性肾上腺皮质功能不全伴甲状腺毒症的情况下，给予小剂量类固醇。第二天早上，疲劳完全缓解，尽管游离T4仍然很高，促甲状腺激素仍然很低。因此，在我们的病例中，由于甲状腺毒症引起的高代谢暴露了肾上腺功能不全。当亚临床肾上腺功能不全患者出现严重急性疲劳时，医生应注意这种罕见但可能致命的并发症。
Sunitinib has recently become a standard treatment for metastatic renal cell carcinoma. However, various adverse events have been reported. We present the first case of clinically evident adrenal insufficiency during sunitinib therapy. A 72-year-old man began sunitinib therapy for bilateral lung and adrenal metastases of renal cell carcinoma. His adrenocorticotrophic hormone level was 93.6 pg/ml (7.263.3 pg/ml) before sunitinib treatment, indicating that subclinical adrenal insufficiency already existed. Fatigue, which is a frequently seen adverse effect of sunitinib treatment, emerged acutely on Day 24 of the second cycle. Adrenocorticotrophic hormone and free T4 were high and thyroid-stimulating hormone was suppressed. Under the clinical diagnosis of acute adrenal insufficiency with thyrotoxicosis, a low dose of steroid was administered. Fatigue was completely ameliorated by the following morning, although free T4 was still high and thyroid-stimulating hormone was still low. Therefore, hypermetabolism due to thyrotoxicosis unmasked adrenal insufficiency in our case. Physicians should be aware of this rare but potentially fatal complication when severe acute fatigue develops in patients with subclinical adrenal insufficiency.