Tyrosine Kinase Inhibitors’ Newly Reported Endocrine Side Effect: Pazopanib-Induced Primary Adrenal Insufficiency in a Patient With Metastatic Renal Cell Cancer

Elshimy, Ghada; Gandhi, Anand; Guo, Rong; Correa, Ricardo

doi:10.1177/2324709620936808

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Further to this, Elshimy et al [3] have reported a case of primary adrenal insufficiency in the setting of pazopanib therapy for mRCC. This patient had previously undergone unilateral nephrectomy and adrenalectomy, but had no documented history of hypoadrenalism.…”

Section: Discussionmentioning

confidence: 92%

“…Subsequent investigations demonstrated hypoadrenalism, and secondary causes were all ruled out. Thus, this was reported as a case of primary adrenal insufficiency associated with pazopanib therapy [3].…”

Section: Discussionmentioning

confidence: 99%

“…Within the product information for this medication, adrenal toxicity is listed as a recognized toxicity, but its clinical significance has yet to be determined [1]. Two previous case reports have been published describing TKI-induced adrenal insufficiency with sunitinib and another TKI, pazopanib [2, 3]. We report a case of presumed sunitinib-induced adrenal crisis in a patient with established hypopituitarism and hypoadrenalism in the setting of previous immunotherapy use.…”

Section: Introductionmentioning

confidence: 99%

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Sunitinib-Induced Adrenal Crisis in a Patient with Pre-Existing Immunotherapy-Related Hypopituitarism

et al. 2022

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Sunitinib is a tyrosine kinase inhibitor that is frequently used in the treatment of metastatic renal cell carcinoma (mRCC). As a multikinase inhibitor, numerous off-target side effects of this medication are widely recognized. More recently, endocrine side effects, including hypoadrenalism, are becoming more apparent. We report a case in which a 71-year-old female experienced recurrent adrenal crises when managed with sunitinib for mRCC on a background of immune-related hypopituitarism and hypoadrenalism as a result of previous treatment with immunotherapy. Clinicians should be aware of this potential toxicity when using such medications and consider further investigation in the appropriate clinical setting.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sunitinib-Induced Adrenal Crisis in a Patient with Pre-Existing Immunotherapy-Related Hypopituitarism

et al. 2022

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“…Recently, PAI induced by pazopanib has been reported in a patient affected by metastatic kidney cancer [63]. No specific measure aimed at monitoring and preventing the risk of AI are cautioned for patients under these TKIs.…”

Section: Tki-induced Adrenal Insufficiencymentioning

confidence: 99%

Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Barnabei

Senes

Scoppola

et al. 2022

Cancers

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Immune checkpoint inhibitors (ICIs) have improved survival in patients affected by several solid tumours at the cost of new autoimmune adverse events. Endocrine toxicity is frequently reported in patients treated with these agents, mainly as thyroid dysfunction and hypophysitis. Primary adrenal insufficiency is reported in 1–2% of patients receiving a single ICI, but its rate is approximately 5% in patients treated with a combination of two ICIs. The clinical presentation of adrenal insufficiency may be insidious due to symptoms that are not specific. The same symptoms in cancer patients are frequently multifactorial, rendering the early diagnosis of adrenal insufficiency challenging in this group of patients. As adrenal insufficiency can be fatal if not rapidly diagnosed and treated, oncologists should be aware of its clinical presentations to timely involve endocrinologists to offer patients the appropriate management. In parallel, it is essential to educate patients, their caregivers, and relatives, providing them with detailed information about the risk of adrenal insufficiency and how to manage alarming symptoms at their onset. Finally, large collaborative trials are needed to develop appropriate tests to assess better the personal risk of drug-induced adrenal insufficiency and its early diagnosis and treatment, not only in cancer patients.

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“…3 So far, one case of pazopanib associated primary adrenal insufficiency has been reported in the literature. 4 To the best of our knowledge, no case reporting secondary adrenal insufficiency due to pazopanib has been reported.…”

Section: Introductionmentioning

confidence: 95%

Pazopanib-associated secondary adrenal insufficiency in a patient with malignant solitary fibrous tumor

Araz

Karabacak

et al. 2021

J Oncol Pharm Pract

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Introduction Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib. Case report A 69-year-old male patient was operated in June 2019 due to a lung mass 26 × 18 × 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported. Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib. Discussion A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.

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Tyrosine Kinase Inhibitors’ Newly Reported Endocrine Side Effect: Pazopanib-Induced Primary Adrenal Insufficiency in a Patient With Metastatic Renal Cell Cancer

Cited by 8 publications

References 17 publications

Sunitinib-Induced Adrenal Crisis in a Patient with Pre-Existing Immunotherapy-Related Hypopituitarism

Sunitinib-Induced Adrenal Crisis in a Patient with Pre-Existing Immunotherapy-Related Hypopituitarism

Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Pazopanib-associated secondary adrenal insufficiency in a patient with malignant solitary fibrous tumor

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