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Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review

Immune checkpoint inhibitors (ICIs) are novel drugs with a dramatic survival benefit in patients with advanced malignancies. With the widespread use, several immune-related adverse events (irAEs) have emerged, which may be life-threatening. Herein we report two patients with adrenal crisis who recei...

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Autores principales: Geng, Dandan, Wang, Yingnan, Zhang, Xin, Zhao, Chenguang, Fan, Yao, Liu, Chang, Wei, Jinmei, Huo, Bingjie, Zhao, Yang, Zhang, Fengbin, Zhang, Ruixing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403738/
https://www.ncbi.nlm.nih.gov/pubmed/36033475
http://dx.doi.org/10.3389/fonc.2022.981084
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author Geng, Dandan
Wang, Yingnan
Zhang, Xin
Zhao, Chenguang
Fan, Yao
Liu, Chang
Wei, Jinmei
Huo, Bingjie
Zhao, Yang
Zhang, Fengbin
Zhang, Ruixing
author_facet Geng, Dandan
Wang, Yingnan
Zhang, Xin
Zhao, Chenguang
Fan, Yao
Liu, Chang
Wei, Jinmei
Huo, Bingjie
Zhao, Yang
Zhang, Fengbin
Zhang, Ruixing
author_sort Geng, Dandan
collection PubMed
description Immune checkpoint inhibitors (ICIs) are novel drugs with a dramatic survival benefit in patients with advanced malignancies. With the widespread use, several immune-related adverse events (irAEs) have emerged, which may be life-threatening. Herein we report two patients with adrenal crisis who received anti-programmed cell death protein 1 (PD-1) (pembrolizumab) therapy. Several reports of secondary adrenal insufficiency caused by pembrolizumab exist, including during treatment or late onset. Severe adrenal insufficiency according to the Common Terminology Criteria for Adverse Events (CTCAE) has rarely been described in the literature, since it initially manifests as high-grade fever. The two male patients developed adrenal crisis that was first characterized by hyperpyrexia accompanied by abdominal symptoms. These initial manifestations confused the clinicians who misdiagnosed them as infection. Timely identification, hydrocortisone pulse therapy, and fluid resuscitation improved the patients’ condition. Compliance with the standardized treatment approach and course can prevent or relieve the crisis as soon as possible. Assessment of relevant laboratory test results and patient education, including when to use stress-dose hydrocortisone and guidance on route of administration, can reduce the incidence of adrenal crisis. We report these two cases and have evaluated the literature on previously reported cases to improve our understanding of this condition and offer a more scientific approach to diagnosis and treatment options.
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spelling pubmed-94037382022-08-26 Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review Geng, Dandan Wang, Yingnan Zhang, Xin Zhao, Chenguang Fan, Yao Liu, Chang Wei, Jinmei Huo, Bingjie Zhao, Yang Zhang, Fengbin Zhang, Ruixing Front Oncol Oncology Immune checkpoint inhibitors (ICIs) are novel drugs with a dramatic survival benefit in patients with advanced malignancies. With the widespread use, several immune-related adverse events (irAEs) have emerged, which may be life-threatening. Herein we report two patients with adrenal crisis who received anti-programmed cell death protein 1 (PD-1) (pembrolizumab) therapy. Several reports of secondary adrenal insufficiency caused by pembrolizumab exist, including during treatment or late onset. Severe adrenal insufficiency according to the Common Terminology Criteria for Adverse Events (CTCAE) has rarely been described in the literature, since it initially manifests as high-grade fever. The two male patients developed adrenal crisis that was first characterized by hyperpyrexia accompanied by abdominal symptoms. These initial manifestations confused the clinicians who misdiagnosed them as infection. Timely identification, hydrocortisone pulse therapy, and fluid resuscitation improved the patients’ condition. Compliance with the standardized treatment approach and course can prevent or relieve the crisis as soon as possible. Assessment of relevant laboratory test results and patient education, including when to use stress-dose hydrocortisone and guidance on route of administration, can reduce the incidence of adrenal crisis. We report these two cases and have evaluated the literature on previously reported cases to improve our understanding of this condition and offer a more scientific approach to diagnosis and treatment options. Frontiers Media S.A. 2022-08-11 /pmc/articles/PMC9403738/ /pubmed/36033475 http://dx.doi.org/10.3389/fonc.2022.981084 Text en Copyright © 2022 Geng, Wang, Zhang, Zhao, Fan, Liu, Wei, Huo, Zhao, Zhang and Zhang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Geng, Dandan
Wang, Yingnan
Zhang, Xin
Zhao, Chenguang
Fan, Yao
Liu, Chang
Wei, Jinmei
Huo, Bingjie
Zhao, Yang
Zhang, Fengbin
Zhang, Ruixing
Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title_full Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title_fullStr Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title_full_unstemmed Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title_short Clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: Case reports and literature review
title_sort clinical course and management of insidious adrenal crisis manifested initially as hyperpyrexia secondary to pembrolizumab: case reports and literature review
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403738/
https://www.ncbi.nlm.nih.gov/pubmed/36033475
http://dx.doi.org/10.3389/fonc.2022.981084
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