一例程序性死亡受体1抑制剂导致多发内分泌腺病病例报道及文献复习  

A case report of polyglandular syndrome induced by programmed death-1 inhibitor and literature review

作　　者：王垚 李宝 张赛春 谷伟军 程愈 倪奇 吕朝晖 巴建明 窦京涛 母义明 Wang Yao;Li Bao;Zhang Saichun;Gu Weijun;Cheng Yu;Ni Qi;Lyu Chaohui;Ba Jianming;Dou Jintao;Mu Yiming(Department of Endocrinology,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Endocrinology,82nd Group Army Hospital of Chinese PLA,Baoding 071000,China)

机构地区：[1]中国人民解放军总医院第一医学中心内分泌科,北京100853 [2]中国人民解放军第82集团军医院内分泌科,保定071000

出　　处：《中华内分泌代谢杂志》2021年第5期462-466,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：本文报道1例程序性死亡受体1(programmed death-1,PD-1)抑制剂导致的多发内分泌腺体功能减退病例。患者男性51岁,因非小细胞肺癌术后PET-CT检查,发现隆突下肿大淋巴结考虑转移,接受PD-1抑制剂治疗共14个周期,治疗过程中出现原发性甲状腺功能减退、1型糖尿病,停用PD-1抑制剂后5个月出现乏力、出汗、低血糖,化验提示垂体前叶功能减退[继发性肾上腺皮质功能减退、生长激素(GH)/胰岛素样生长因子1(IGF-1)减低],给予泼尼松龙替代治疗后症状缓解。本例为国内报道的首例PD-1抑制剂导致的多发内分泌腺病病例,特别是停药后患者甲状腺功能减退、1型糖尿病无明显改善而垂体前叶功能减退进一步加重,提示接受PD-1抑制剂治疗的患者,治疗过程中及停药后均需注意监测甲状腺、垂体、胰腺、肾上腺等内分泌腺功能指标变化,以便及时发现并正确采取医疗措施避免漏诊误治,改善预后。We reported a case of polyglandular syndrome induced by programmed death-1(PD-1)inhibitors.The patient was a 51-years-old male with non-small cell lung cancer,treated with PD-1 inhibitor nivolumab/pembrolizumab because of postoperative subcarinal lymph node metastasis indicated by PET-CT.During 14 cycles of PD-1 inhibitor treatment,the patient successively developed primary hypothyroidism,and type 1 diabetes mellitus(T1DM).More than five months after the withdrawal of pembrolizumab,the patient experienced recurrentce.Laboratory examinations showed mild hyponatremia and hypopituitarism including ACTH and growth hormone(GH)/insulin-like growth factor-1(IGF-1)insufficiency.This is the first report of a patient diagnosed as polyglandular syndrome caused by PD-1 inhibitor.In particularly,the hypothyroidism and T1DM did not improve after drug withdrawal,while hypopituitarism was further aggravated.This case reminds us that we should pay more attention to the changes of endocrine function during and after the treatment of PD-1 inhibitor,so that we can make the correct diagnosis and take proper medical measures timely,to avoide missed diagnosis,and improper treatment.

关 键 词：程序性死亡受体1抑制剂 多内分泌腺病 甲状腺功能减退症 糖尿病 1型 垂体前叶功能减退症 

分 类 号：R969.3[医药卫生—药理学]