Carla Colombo, Daniele Ceruti, Massimiliano Succi, Simone De Leo, Matteo Trevisan, Claudia Moneta, Laura Fugazzola
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引用次数: 0
摘要
背景:疲劳是晚期甲状腺癌全身治疗过程中经常出现的不良反应,常常导致减量、中断或停药。我们是第一个证明疲劳与原发性肾上腺功能不全(PAI)之间存在相关性的研究小组。目的:评估接受系统治疗的患者的整个肾上腺功能:方法:每月对36名患者(25名服用来伐替尼、6名服用凡德他尼、5名服用赛乐替尼)的促肾上腺皮质激素、皮质醇和肾上腺分泌的所有激素进行评估。对26例患者进行了促肾上腺皮质激素刺激试验。结果中位治疗期为7个月后,我们观察到80%至100%的患者促肾上腺皮质激素(ACTH)值升高,19%的患者对ACTH试验的皮质醇反应减弱。此外,无论使用何种药物,大多数患者的硫酸脱氢表雄酮、Δ-4-雄烯二酮和 17-OH 孕酮水平都低于正常值的中位数(n.v.)。在服用来伐替尼和凡德他尼的大多数患者中,女性的睾酮和男性的雌二醇均低于正常值的中位数(n.v.)。最后,在大多数情况下,醛固酮低于正常值的中位数,而肾素水平正常。甲肾上腺素和去甲肾上腺素始终在正常范围内。醋酸可的松替代疗法改善了 14/17 例 PAI 患者(82%)的疲劳状况:我们的数据证实,晚期甲状腺癌的全身治疗可导致皮质醇分泌受损。肾上腺皮质分泌的其他激素减少也是首次报道,在对这些脆弱的患者进行更适当的管理时应考虑到这一点。
IMPACT OF SYSTEMIC TREATMENTS FOR ADVANCED THYROID CANCER ON THE ADRENAL CORTEX
Background: Fatigue is a frequent adverse event during systemic treatments for advanced thyroid cancer, often leading to reduction, interruption or discontinuation. We were the first group to demonstrate a correlation between fatigue and primary adrenal insufficiency (PAI).
Aim: To assess the entire adrenal function in patients on systemic treatments.
Methods: ACTH, cortisol and all the hormones produced by the adrenal gland were evaluated monthly in 36 patients (25 on lenvatinib, 6 on vandetanib, and 5 on selpercatinib). ACTH stimulation test was performed in 26 cases.
Results: After a median treatment period of 7 months, we observed an increase in ACTH values in 80-100% of patients, and an impaired cortisol response to ACTH test in 19% of cases. Additionally, dehydroepiandrosterone sulphate, ∆-4-Androstenedione and 17-OH progesterone levels were below the median of normal values (n.v.) in the majority of patients regardless of the drug used. Testosterone in females and oestradiol in males were below the median of n.v. in the majority of patients on lenvatinib and vandetanib. Finally, aldosterone was below the median of the n.v. in most cases, while renin levels were normal. Metanephrines and normetanephrines were always within the normal range. Replacement therapy with cortisone acetate improved fatigue in 14/17 (82%) patients with PAI.
Conclusions: Our data confirm that systemic treatments for advanced thyroid cancer can lead to an impaired cortisol secretion. A reduction in the other hormones secreted by the adrenal cortex has been firstly reported and should be considered in the more appropriate management of these fragile patients.
期刊介绍:
The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.