Scholarlink

Background <p>Gastric cancer is one of the most prevalent and deadly malignancies worldwide. In recent years, with the development of immune checkpoint inhibitors (such as PD-1/PD-L1 and CTLA-4 inhibitors), immunotherapy has emerged as a new strategy in gastric cancer treatment. However, the incidence of immune-related adverse events (irAEs) has also increased. Here, we report eleven cases of gastric cancer patients who developed pituitary or adrenal cortisol insufficiency in the first postoperative week following neoadjuvant immunotherapy.</p> Case presentation <p>We present a retrospective analysis of patients who underwent surgical resection for gastric cancer at our center starting from December 2023. We evaluated their perioperative cortisol function and identified those who developed perioperative cortisol insufficiency, and identified eleven gastric cancer patients with normal cortisol functions who had received neoadjuvant immunotherapy, and subsequently experienced postoperative changes within a short period following surgery. Among them, six patients showed decreased ACTH and cortisol levels, four patients had reduced cortisol levels, and one patient with no ACTH testing also showed reduced cortisol levels. Six patients received hormone replacement therapy, with one developing anastomotic leakage after surgery. Notably, cortisol function was normal in all eleven patients preoperatively. All patients exhibited decreased cortisol function postoperatively, and 27% of them experienced irAE during preoperative treatment.</p> Conclusion <p>This case series is the first in the world that reports on gastric cancer patients who developed pituitary insufficiency or cortisol insufficiency after surgery, potentially linked to the combined effects of immunotherapy and surgery. This series emphasizes the importance of monitoring for immune-related adverse events in patients presenting with symptoms such as fatigue, weakness, and hypotension after surgery. Prompt evaluation of pituitary and adrenal cortical function can reduce the risk of complications associated with postoperative cortisol insufficiency, thereby alleviating patient suffering.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Post-gastric cancer surgery hypophysitis and cortisol insufficiency after immunotherapy: a case series

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月13日

查看全文
  • Zhouqiao Wu,
  • Minghui Shi,
  • Fei Shan,
  • Shuangxi Li,
  • Yinkui Wang,
  • Kan Xue,
  • Ziyu Li,
  • Jiafu Ji

摘要

Background

Gastric cancer is one of the most prevalent and deadly malignancies worldwide. In recent years, with the development of immune checkpoint inhibitors (such as PD-1/PD-L1 and CTLA-4 inhibitors), immunotherapy has emerged as a new strategy in gastric cancer treatment. However, the incidence of immune-related adverse events (irAEs) has also increased. Here, we report eleven cases of gastric cancer patients who developed pituitary or adrenal cortisol insufficiency in the first postoperative week following neoadjuvant immunotherapy.

Case presentation

We present a retrospective analysis of patients who underwent surgical resection for gastric cancer at our center starting from December 2023. We evaluated their perioperative cortisol function and identified those who developed perioperative cortisol insufficiency, and identified eleven gastric cancer patients with normal cortisol functions who had received neoadjuvant immunotherapy, and subsequently experienced postoperative changes within a short period following surgery. Among them, six patients showed decreased ACTH and cortisol levels, four patients had reduced cortisol levels, and one patient with no ACTH testing also showed reduced cortisol levels. Six patients received hormone replacement therapy, with one developing anastomotic leakage after surgery. Notably, cortisol function was normal in all eleven patients preoperatively. All patients exhibited decreased cortisol function postoperatively, and 27% of them experienced irAE during preoperative treatment.

Conclusion

This case series is the first in the world that reports on gastric cancer patients who developed pituitary insufficiency or cortisol insufficiency after surgery, potentially linked to the combined effects of immunotherapy and surgery. This series emphasizes the importance of monitoring for immune-related adverse events in patients presenting with symptoms such as fatigue, weakness, and hypotension after surgery. Prompt evaluation of pituitary and adrenal cortical function can reduce the risk of complications associated with postoperative cortisol insufficiency, thereby alleviating patient suffering.