Adrenal crisis caused by combination chemotherapy with vincristine, etoposide, and carboplatin in a child
10.3760/cma.j.cn114015-20240914-00047
- VernacularTitle:长春新碱和依托泊苷及卡铂联合化疗致儿童肾上腺危象
- Author:
Qing GUO
1
;
Yue WU
Author Information
1. 广西医科大学附属肿瘤医院药学部，南宁 530021
- Publication Type:Journal Article
- Keywords:
Antineoplastic agents;
Vincristine;
Carboplatin;
Etoposide;
Adrenal crisis;
Adverse drug reactions
- From:
Adverse Drug Reactions Journal
2025;27(6):372-374
- CountryChina
- Language:Chinese
-
Abstract:
A 5-year-old male patient with congenital adrenal hyperplasia and 21 hydroxylase deficiency was treated with intervention, laser, left eye retinoblastoma resection, and retinal repositioning surgery for left eye retinoblastoma at the age of 2 years and 3 months. At the age of 3 years and 4 months, the child underwent peritoneal tumor resection and partial adrenalectomy for adrenal neuroblastoma. Hydrocortisone 2.5 mg thrice daily orally and fludrocortisone 0.02 mg once daily orally were given regularly for a long time after surgery. Three years after the resection of the left eye retinoblastoma, the tumor recurred and the child underwent another resection and retinal retinal repositioning surgery for the left eye retinoblastoma. After the surgery, he received a combination chemotherapy of vincristine (1.06 mg by intravenous infusion on day 1), etoposide (105 mg by intravenous infusion on days 1-2), and carboplatin (395 mg by intravenous infusion on day 1) (VEC) for left retinoblastoma, with 28 days as one treatment cycle. After 2 days of medication, the child experienced nausea, vomiting, and abdominal discomfort. After 5 days, he developed pale complexion, nausea, vomiting, and poor mental state. Laboratory tests showed cortisol 29.6 μg/L, blood sodium 133 mmol/L, and random blood glucose 2.4 mmol/L. Adrenal crisis caused by VEC chemotherapy was considered. Oral hydrocortisone was stopped and switch to intravenous infusion of hydrocortisone 10 mg thrice daily, while symptomatic treatment such as sodium supplementation was given. After 2 days, the symptoms of the child were improved. After 7 days, the child had no nausea or vomiting, cortisol increased to 291.0 μg/L, and blood sodium and blood glucose returned to normal.
