Zheng Y, Zhu CY, Lin J, Chen WS, Wang YJ, Fu HY, Zhao Q. Hypophysitis induced by anti-programmed cell death protein 1 immunotherapy in non-small cell lung cancer: Three case reports. World J Clin Cases 2022; 10(30): 11049-11058 [PMID: 36338199 DOI: 10.12998/wjcc.v10.i30.11049]
Corresponding Author of This Article
Qiong Zhao, PhD, Doctor, Zhejiang University School of Medicine, Zhejiang University, No. 866 Yuhangtang Road, Xihu District, Hangzhou 310030, Zhejiang Province, China. jade1972@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yun Zheng, Chen-Yu Zhu, Qiong Zhao, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310030, Zhejiang Province, China
Yun Zheng, Chen-Yu Zhu, Jing Lin, Wang-Shan Chen, Yu-Jie Wang, Hong-Ye Fu, Qiong Zhao, Department of Thoracic Oncology, Shulan (Hangzhou) Hospital affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
Yu-Jie Wang, Hong-Ye Fu, Zhejiang Chinese Medical University, Hangzhou 311402, Zhejiang Province, China
Author contributions: Zheng Y and Zhu CY designed the study, drafted the manuscript, and reviewed the manuscript; Zheng Y, Zhu CY, and Lin J performed the literature review; Lin J was involved in supervision and manuscript review and editing; Chen WS contributed to the data curation and investigation; Wang YJ and Fu HY conducted the study and suggested pertinent modification; Zhao Q supervised the study process and reviewed the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiong Zhao, PhD, Doctor, Zhejiang University School of Medicine, Zhejiang University, No. 866 Yuhangtang Road, Xihu District, Hangzhou 310030, Zhejiang Province, China. jade1972@126.com
Received: May 12, 2022 Peer-review started: May 12, 2022 First decision: June 16, 2022 Revised: July 9, 2022 Accepted: September 16, 2022 Article in press: September 16, 2022 Published online: October 26, 2022 Processing time: 161 Days and 22.4 Hours
Abstract
BACKGROUND
Hypophysitis induced by programmed cell death 1 protein (PD-1) immune checkpoint inhibitors is rare and poorly described. We report three patients with non-small cell lung cancer who developed hypophysitis after anti-PD-1 immunotherapy.
CASE SUMMARY
Both case 1 and case 2 presented with common symptoms of fatigue, nausea, and vomiting. However, case 3 showed rare acute severe symptoms such as hoarse voice, bucking, and difficulty in breathing even when sitting. Following two cycles of immunotherapy in case 3, the above severe symptoms and pituitary gland enlargement were found on magnetic resonance imaging at the onset of hypophysitis. These symptoms were relieved after 10 d of steroid treatment. Case 3 was the first patient with these specific symptoms, which provided a new insight into the diagnosis of hypophysitis. In addition, we found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy. Case 3 was treated with high-dose hormone therapy and her pituitary-corticotropic axis dysfunction returned to normal after more than 6 mo of steroid treatment. Cases 1 and 2 were treated with the low-dose hormone, and dysfunction of the pituitary-corticotropic axis was still present after up to 7 mo of steroid treatment.
CONCLUSION
The clinical symptoms described in this study provide a valuable reference for the diagnosis and treatment of immune-related hypophysitis.
Core Tip: Hypophysitis induced by programmed cell death 1 protein (PD-1) inhibitor treatment in non-small cell lung cancer (NSCLC) was rarely reported. In this study, we report three patients with NSCLC who developed hypophysitis induced by PD-1 immune checkpoint inhibitor treatment. Our study suggested that unexpected fatigue, appetite decreases, nausea, vomiting, hoarse voice, bucking, and difficulty breathing were largely correlated with immune-related hypophysitis. We also found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy. This work provided a reference for the diagnosis and timely treatment of hypophysitis in the clinic.
