Yeungnam Univ J Med.  2016 Dec;33(2):155-158. 10.12701/yujm.2016.33.2.155.

Secondary adrenal insufficiency caused by sorafenib administration in a patient with hepatocellular carcinoma

• Jo SY
• Ryu SH
• Kim MY
• Moon JS
• Yoon WJ
• Kim JN

• KMID: 2366131
• DOI: http://doi.org/10.12701/yujm.2016.33.2.155

Abstract

Sorafenib (Nexavar) has been regarded as a treatment for unresectable hepatocellular carcinoma (HCC), with side effects that include hand-foot skin reaction, diarrhea, rash, fatigue, hypertension, nausea, anorexia, weight loss, and alopecia. Thyroid disorder, such as endocrine side effect, has also been reported. However no case involving adrenal insufficiency has been reported. Here, we report a case of adrenal insufficiency which occurred after taking sorafenib in a patient with HCC. A 56-year-old man visited our hospital due to right upper quadrant abdominal pain and he was diagnosed as multiple disseminated and unresectable HCCs with portal vein invasion; therefore transarterial chemoembolization was performed and sorafenib administration was started. Two months later, he was admitted to the hospital complaining of severe fatigue. The laboratory results showed cortisol of <0.2µ g/dL and adrenocorticotropic hormone of <1.00 pg/mL. The patient had no history of taking steroids or herbal medications. Secondary adrenal insufficiency was diagnosed and prednisolone 10 mg per day was started immediately; as a result, fatigue remarkably improved. This may be the first report indicating a possible association between sorafenib and adrenal insufficiency and it implies that the possibility of adrenal insufficiency should be considered in patients taking sorafenib who complain of severe fatigue.

Keyword

Hepatocellular carcinoma; Sorafenib; Adrenal insufficiency; Adverse effects

MeSH Terms

Abdominal Pain
Adrenal Insufficiency*
Adrenocorticotropic Hormone
Alopecia
Anorexia
Carcinoma, Hepatocellular*
Diarrhea
Exanthema
Fatigue
Humans
Hydrocortisone
Hypertension
Middle Aged
Nausea
Portal Vein
Prednisolone
Skin
Steroids
Thyroid Gland
Weight Loss
Adrenocorticotropic Hormone
Hydrocortisone
Prednisolone
Steroids