ArticleClinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology2026
Endocrine dysfunction induced by anti-PD-1 antibody and tyrosine kinase inhibitor in a pediatric patient with renal cell carcinoma.
Article in Clinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In recent years, the use of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) has increased and has demonstrated excellent antitumor effects. However, immunotherapy in pediatric patients remains limited, and knowledge of endocrine-related adverse effects is scarce. Here, we report a pediatric case of hypothyroidism and adrenal insufficiency following treatment with a combination of ICI and TKI for renal cell carcinoma. Seven weeks after treatment initiation, laboratory tests revealed free thyroxine at the lower limit of the reference range (fT4 0.96 ng/dL) and elevated thyroid-stimulating hormone (TSH 20 µIU/mL), without clinical symptoms, consistent with hypothyroidism. Three months after treatment initiation, abnormally high early morning fasting ACTH levels were observed, and the patient subsequently developed nausea and fatigue. A rapid ACTH stimulation test revealed a peak cortisol level of 12.1 µg/dL, and urinary free cortisol was low (19.2 µg/d; 13.6 µg/m
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