中国神经再生研究(英文版) ›› 2020, Vol. 15 ›› Issue (6): 1166-1168.doi: 10.4103/1673-5374.270420

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帕唑帕尼诱导的后可逆性脑病综合征可能伴有抗利尿激素分泌不当的综合征:偶然或病理生理学关联?

  

  • 出版日期:2020-06-15 发布日期:2020-07-05

Pazopanib-induced posterior reversible encephalopathy syndrome with possible syndrome of inappropriate secretion of antidiuretic hormone: an incidental or pathophysiological association?

Jonathan Wong So1, Bérenger Largeau2, Frédérique Beau-Salinas3, Stephan Ehrmann4, Christophe Magni5, Jérôme Meunier1   

  1. 1 CHR d’Orléans, Service d’Oncologie Médicale, Orléans, France
    2 CHRU de Tours, Centre d’Investigation Clinique - CIC INSERM 1415, Tours, France
    3 CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France 4 Université de Tours, INSERM, Centre d’étude des pathologies respiratoires (CEPR) - UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC INSERM 1415, réseau CRICS-TRIGGERSEP, Tours, France 
    5 CHR d’Orléans, Service de Neuroradiologie, Orléans, France
  • Online:2020-06-15 Published:2020-07-05
  • Contact: Bérenger Largeau, PharmD resident,berenger.largeau@etu.univ-tours.fr.

摘要:

此文报道了帕唑帕尼诱导的后可逆性脑病综合征与低钠血症同时发生的病例,其可能是由于抗利尿激素分泌异常综合征。在帕唑帕尼治疗转移性透明细胞肾癌的第15天,一例73岁的女性在肿瘤科接受帕唑帕尼治疗后出现了高血压急症和额部头痛。脑磁共振成像显示与后可逆性脑病综合征一致的左枕顶叶白质血管性水肿。入院时的血液生化检查发现与抗利尿激素分泌异常综合征机制一致的低渗性低钠血症。治疗包括帕唑帕尼停药,液体限制和抗高血压治疗。该患者临床结局良好,后可逆性脑病综合征诊断后2个月重新接受帕唑帕尼治疗,未出现复发。后可逆性脑病综合征和抗利尿激素分泌异常综合征之间的病理生理联系可能解释了这两种综合征的关联。

orcid: 0000-0002-6824-7283 (Bérenger Largeau)

Abstract: Pazopanib is an oral protein kinase inhibitor (PKI) that targets vascular endothelial growth factor (VEGF) receptors, fibroblastic growth factor receptors, platelet-derived growth factor receptors, and stem cell factor that inhibits VEGF-induced cellular proliferation. Pazopanib is approved for use in advanced renal cell carcinoma and subtypes of advanced soft-tissue sarcoma (Deguchi et al., 2018). Major adverse drug reactions of pazopanib include hyper- tension, high-grade hyponatremia and posterior reversible encepha- lopathy syndrome (PRES) (Berardi et al., 2016; Deguchi et al., 2018). In clinical trials, few investigations have been conducted to deter- mine the aetiology of PKI-associated hyponatremia, the mechanism remains therefore unknown. Only rare cases of PKI-induced syn- drome of inappropriate secretion of antidiuretic hormone (SIADH) (Largeau et al., 2019), and none with pazopanib, have been reported. PRES is a clinical and radiological entity where a bilateral white mat- ter oedema, occurring predominantly in the posterior occipital and parietal lobes, is associated with several neurologic symptoms. Inter- estingly, a recent review suggests that SIADH could be a symptom of PRES (Largeau et al., 2019). To our knowledge, this is the first case published where pazopanib-induced PRES occurs contemporane- ously with possible SIADH.