Table 3.
Adrenal Function Before and During Lenvatinib Treatment
| Patient No./sex | Cortisol peak before lenvatinib (nmol/L) | ACTH before lenvatinib (pg/mL) | PAI (yes/no) | PAI diagnosis after lenvatinib started (months) | Cortisol peak at PAI diagnosis (nmol/L) | ACTH at PAI diagnosis (pg/mL) |
|---|---|---|---|---|---|---|
| 1/F | 661 | 16.2 | No | / | / | / |
| 2/M | 765 | 21.1 | No | / | / | / |
| 3/F | 670 | 11.9 | No | / | / | / |
| 4/M | 540 | 26.7 | Yes | 3 | 418 | 56.8 |
| 5/M | 575 | 39.4 | No | / | / | / |
| 6/F | 598 | 25.2 | Yes | 3 | 432 | 70.2 |
| 7/F | 669 | 34 | No | / | / | No |
| 8/F | 672 | 26.4 | Yes | 3 | 421 | 31.5 |
| 9/M | 584 | 39 | Yes | 9 | 268 | 95.7 |
| 10/F | 598 | 36.5 | Yes | 18 | 452 | 65.3 |
| 11/F | 582 | 34.2 | Yes | 6 | 328 | 91 |
| 12/F | 632 | 35.3 | Yes | 12 | 430 | 197.1 |
| 13/M | 832 | 42 | No | / | / | / |
ACTH normal level: 6–48.8 pg/mL. None of the 13 patients had PAI before starting treatment; in all cases the cortisol peak was higher than 500 nmol/L. Seven of the 13 patients developed PAI during lenvatinib treatment; cortisol peak after ACTH stimulation and ACTH level were reported at the time of PAI diagnosis in the seven patients. Six of the seven patients with PAI had increased ACTH levels at the time of diagnosis. In one patient without an increase in ACTH levels (patient #8), we excluded a pituitary origin by evaluating other pituitary hormones using pituitary magnetic resonance. However, during follow-up, this patient manifested high levels of ACTH (maximum value 61.5 pg/mL, 9 months after the start of lenvatinib treatment).