• Internal medicine · Nov 2023

    Isolated adrenocorticotropic hormone deficiency associated with atezolizumab and bevacizumab administration for treating hepatocellular carcinoma: a case series.

    • Yuji Ikeda, Shunsuke Sato, Rifa Omu, Arisa Nishimura, Shin Arii, Ryota Uchida, Kei Nomura, Sho Sato, Ayato Murata, Yuji Shimada, and Takuya Genda.
    • Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Japan.
    • Intern. Med. 2023 Nov 15; 62 (22): 334133463341-3346.

    AbstractAtezolizumab and bevacizumab are currently available as first-line treatments for unresectable hepatocellular carcinoma, but immune-related adverse events are a major concern. We herein report two cases of isolated adrenocorticotropic hormone (ACTH) deficiency. Both patients presented with general fatigue, appetite loss, eosinophilia, and hyponatremia after nine cycles in case 1 and three months after stopping treatment for inflammatory arthritis in case 2. Endocrinological investigations revealed unsatisfactory ACTH and cortisol responses despite the preservation of other anterior pituitary hormones, suggesting isolated ACTH deficiency. As it is rapidly improved by steroid replacement therapy, an early diagnosis and treatment make it possible to resume immunotherapy.

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