2022 Volume 55 Issue 7 Pages 453-458
The patient was a 69-year-old male. He had been on hemodialysis since 2011 due to nephrosclerosis. He underwent open left nephrectomy for left renal cell carcinoma in June 2020. In July 2021, computed tomography showed multiple lung metastases. His IMDC risk classification was intermediate, and immune checkpoint inhibitor therapy (nivolumab-ipilimumab combination therapy) was started in August 2021. His blood pressure decreased rapidly from day 30, and his adrenocorticotropic hormone (ACTH) and cortisol levels tended to decrease；therefore, 20 mg/day hydrocortisone was started from day 35. An ACTH stress test was performed, which showed a normal cortisol response；i.e., he retained adrenal function. A corticotropin-releasing hormone stress test showed a low response for ACTH and no response for cortisol. A thyrotropin-releasing hormone stress test showed no response for thyroid-stimulating hormone and a low response for prolactin. These results were suggestive of panhypopituitarism. After 3 courses of treatment, he achieved a partial response (PR), and after 5 courses, the PR was maintained, and the major lesions had disappeared.
