Internal medicine (Tokyo, Japan) · 2026
A Case of Transient ACTH and Cortisol Suppression Caused by Dexamethasone Mouthwash during Immune Checkpoint Inhibitor Treatment.
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Aoyama Yosuke, Haruyama Yurie, Ozaki Yukinori, Takano Toshimi, Ueno Takayuki
Аннотация
Immune checkpoint inhibitors (ICIs) can cause endocrine adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report a case of transient ACTH and cortisol suppression mimicking ICI-induced IAD during pembrolizumab therapy for metastatic triple-negative breast cancer. A 59-year-old woman developed low ACTH and cortisol levels while receiving pembrolizumab in combination with nab-paclitaxel. ICI-related IAD was initially suspected. However, her hormone levels normalized after the discontinuation of dexamethasone mouthwash used for oral mucositis. These findings suggest the transient suppression of the hypothalamic-pituitary-adrenal axis due to exogenous steroid exposure. Clinicians should consider steroid-containing mouthwashes as a potential cause of adrenal axis suppression during ICI therapy.