中国药物警戒 ›› 2022, Vol. 19 ›› Issue (1): 107-110.
DOI: 10.19803/j.1672-8629.2021.12.24

• 安全与合理用药 • 上一篇    下一篇

帕博利珠单抗致原发性肾上腺功能减退1例及文献分析

孟德辉1,2, 王伟兰2,*   

  1. 1安阳市人民医院,河南 安阳 455000;
    2解放军总医院临床药学中心,北京 100853
  • 收稿日期:2020-02-25 出版日期:2022-01-15 发布日期:2022-01-20
  • 通讯作者: *王伟兰,女,副主任药师,临床药学。E-mail：wangweilan50@sohu.com。
  • 作者简介:孟德辉,女,药师,临床药学。

One case of primary adrenal insufficiency induced by pembrolizumab

MENG Dehui1,2, WANG Weilan2,*   

  1. 1Anyang People's Hospital, Anyang Henan 455000, China;
    2Department of Clinical Pharmacy Center, PLA General Hospital, Beijing 100853, China
  • Received:2020-02-25 Online:2022-01-15 Published:2022-01-20

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摘要： 目的 探讨帕博利珠单抗致原发性肾上腺功能减退的发病机制及管理措施。方法 分析1例帕博利珠单抗致原发性肾上腺功能减退的诊疗经过,结合文献分析,阐述帕博利珠单抗与原发性肾上腺功能减退不良反应的因果关系、发生率、发病机制和处理措施。结果 患者静脉使用帕博利珠单抗6个月后出现明显乏力、体力差、食欲差、皮肤变黑症状。入院行实验室检查8AM血清促肾上腺皮质激素（ACTH）16.7 pmol·L-1,8AM血清皮质醇 <25.7 nmol·L-1,考虑为帕博利珠单抗致原发性肾上腺功能减退。建议暂停帕博利珠单抗治疗,口服醋酸泼尼松片每日2次,每次5 mg用于类固醇激素替代治疗,1周后患者症状好转出院。院外逐渐减少醋酸泼尼松片至5 mg·d-1维持剂量。结论 对帕博利珠单抗致原发性肾上腺功能减退,应根据不良反应分级标准采取相应的分级处理措施。

关键词: 帕博利珠单抗, 原发性肾上腺功能减退, 药品不良反应

Abstract: Objective To investigate the pathogenesis and management of primary adrenal insufficiency caused by pembrolizumab. Methods The diagnosis and treatment process of one case with primary adrenal insufficiency caused by pembrolizumab was analyzed. Based on literature analysis, the causal relationships between pembrolizumab and primary adrenal insufficiency, incidence, pathogenesis and treatments were explored. Results After 6 months of intravenous administration of pembrolizumab, the patient showed obvious symptoms of fatigue, poor physical strength, poor appetite and blackened skin. The patient was hospitalized for laboratory examination of 8AM serum ACTH 16.7 pmol·L-1 and 8AM serum cortisol < 25.7 nmol·L-1. Primary adrenal insufficiency caused by pembrolizumab was suspected. It was recommended that pembrolizumab be suspended, and that oral prednisone (5 mg·time-1, bid) was used as an alternative therapy with steroid hormone. The patient's symptoms improved after one week and he was discharged. The dosage of prednisone was gradually reduced to 5 mg·d-1. Conclusion Primary adrenal insufficiency caused by pembrolizumab should be treated according to the classification standards for adverse reactions.

Key words: pembrolizumab, primary adrenal insufficiency, adverse drug reaction

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