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Xiang J, Liu X, Hao Y, Zhu Y, Wu M, Lou J, Wang Y, Xu C, Xie Y, Huang J. Clinical characteristics and treatment efficacy of immune checkpoint inhibitors (ICIs) in patients with ICIs-induced Adrenal insufficiency. Transl Oncol 2023; 38:101787. [PMID: 37729740 PMCID: PMC10518362 DOI: 10.1016/j.tranon.2023.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Adrenal insufficiency (AI) caused by immune checkpoint inhibitors (ICIs) is an extremely rare immune-related adverse event (irAE). The detailed clinical characteristics and outcomes of patients with ICI-induced AI are unavailable. This study aimed to explore the clinical characteristics and efficacy of treatment in patients with ICI-induced AI. METHODS We retrospectively collected information on patients diagnosed with AI caused by ICIs at LiShui Municipal Central Hospital and Zhejiang Cancer Hospital, including baseline characteristics, laboratory results, symptoms, treatment outcomes of AI, and hormone use. Survival outcomes were calculated using the Kaplan-Meier method and stratified according to the different situations. RESULTS From December 2020 to February 2023, among 1014 patients treated with ICI therapy, a total of twenty patients were diagnosed with ICI-induced AI. Most of the patients were men (80%, n = 16), with a performance status (PS) of 0 - 1 (95%, n = 19). The median (range) age was 65.9 (49-80) years and 14 patients (70%) were treated with ICIs as first-line therapy. The majority of the patients (70%, n = 14) experienced grade 3 - 4 AI. All patients received corticosteroid replacement therapy, and only 7 patients recovered. The median time to the diagnosis of AI after starting ICI therapy was 5.2 (3.0 - 7.5) months. The objective response rate was 70% and median progression-free survival in these patients was 16.0 months (95% confidence interval: 11.7 - 20.3 months). CONCLUSIONS ICI-induced AI is a rare irAE, and close monitoring of cortisol levels is important. Patients diagnosed with AI after receiving immunotherapy seem to have a favorable outcome.
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Affiliation(s)
- Jing Xiang
- Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Xueni Liu
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Yue Hao
- Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yanyan Zhu
- Department of Pharmacy, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Minhua Wu
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Jian Lou
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Yonghui Wang
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Chunwei Xu
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China
| | - Yanru Xie
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China.
| | - Jianhui Huang
- Department of Medical Oncology, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China; The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China.
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Lee KH, Lee H, Lee CH, Kim JY, Kim JM, Kim SS, Jeong S, Hwang IS, Kim N, Kim NE, Shin S, Shin D, Song JS, Shin DH, Kim JD, Kim J, Lee YS, Kang H, Kim DH, Moon SH, Rho WS, Lee JY, Kronbichler A, Shin JI. Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review. Autoimmun Rev 2018; 18:1-8. [PMID: 30408580 DOI: 10.1016/j.autrev.2018.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with systematic lupus erythematosus (SLE) or antiphospholipid syndrome (APS). METHODS A literature search of PubMed and Medline databases was performed and 91 publications containing 105 cases were included for the final analysis. RESULTS The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). APS was present in 73%, SLE in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively. CONCLUSIONS This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.
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Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea
| | - HyunJeong Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Hun Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Yeong Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Min Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Seung Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungmin Jeong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Sung Hwang
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namsoo Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na Eun Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soogeun Shin
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongkwan Shin
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Sang Song
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Shin
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Dong Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Seok Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hansung Kang
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ha Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Hyun Moon
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Suk Rho
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Yeon Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea; Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Gleicher N, Kushnir VA, Darmon SK, Wang Q, Zhang L, Albertini DF, Barad DH. New PCOS-like phenotype in older infertile women of likely autoimmune adrenal etiology with high AMH but low androgens. J Steroid Biochem Mol Biol 2017; 167:144-152. [PMID: 27993552 DOI: 10.1016/j.jsbmb.2016.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/02/2023]
Abstract
How anti-Müllerian hormone (AMH) and testosterone (T) interrelate in infertile women is currently largely unknown. We, therefore, in a retrospective cohort study investigated how infertile women with high-AMH (AMH ≥75th quantile; n=144) and with normal-AMH (25th-75th quantile; n=313), stratified for low-T (total testosterone ≤19.0ng/dL), normal-T (19.0-29.0ng/dL) and high-T (>29.0ng/dL) phenotypically behaved. Patient age, follicle stimulating hormone (FSH), dehyroepiandrosterone (DHEA), DHEA sulphate (DHEAS), cortisol (C), adrenocorticotrophic hormone (ACTH), IVF outcomes, as well as inflammatory and immune panels were then compared between groups, with AMH and T as variables. We identified a previously unknown infertile PCOS-like phenotype, characterized by high-AMH but, atypically, low-T, with predisposition toward autoimmunity. It presents with incompatible high-AMH and low-T (<19.0ng/dL), is restricted to lean PCOS-like patients, presenting delayed for tertiary fertility services. Since also characterized by low DHEAS, low-T is likely of adrenal origina, and consequence of autoimmune adrenal insufficiency since also accompanied by low-C and evidence of autoimmunity. DHEA supplementation in such patients equalizes low- to normal-T and normalizes IVF cycle outcomes. Once recognized, this high-AMH/low-T phenotype is surprisingly common in tertiary fertility centers but, currently, goes unrecognized. Its likely adrenal autoimmune etiology offers interesting new directions for investigations of adrenals control over ovarian function via adrenal androgen production.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY, 10021, United States; The Foundation for Reproductive Medicine, New York, NY 10020, United States; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY 10016, United States; Department of Obstetrics and Gynecology, Vienna University School of Medicine, 1090 Vienna, Austria.
| | - Vitaly A Kushnir
- The Center for Human Reproduction, New York, NY, 10021, United States; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC 27101, United States
| | - Sarah K Darmon
- The Center for Human Reproduction, New York, NY, 10021, United States
| | - Qi Wang
- The Center for Human Reproduction, New York, NY, 10021, United States
| | - Lin Zhang
- The Center for Human Reproduction, New York, NY, 10021, United States
| | - David F Albertini
- The Center for Human Reproduction, New York, NY, 10021, United States; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY 10016, United States
| | - David H Barad
- The Center for Human Reproduction, New York, NY, 10021, United States; The Foundation for Reproductive Medicine, New York, NY 10020, United States
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