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Abiraterone-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Metastatic Prostate Cancer: A Case Report and Literature Review
摘要
Background: The selective CYP17 inhibitor, abiraterone, blocks androgen biosynthesis, and is used in combination with prednisone for treating metastatic prostate cancer. Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome with a characteristic brain image. Here, we report a case of abiraterone therapy induced refractory hypertension and PRES. Methods: This is a case report presenting medical record from a tertiary center in Taiwan. Results: An 82-year-old man, diagnosed with metastatic prostate cancer in January 2020, underwent palliative transurethral prostatectomy in May. As advised by the urologist, post-surgical treatment was initiated with abiraterone alone in June. The patient developed severe headaches and hypertension in July, and was brought to the emergency department owing to deteriorating consciousness. Emergent brain magnetic resonance imaging (MRI) revealed bilateral posterior cerebral focal edema, and initial laboratory data revealed hypokalemia. He was admitted to the intensive care unit. His symptoms responded poorly to treatment. Assessment of secondary hypertension revealed elevated serum levels of adrenocorticotropic hormone (ACTH) and aldosterone, and reduced levels of cortisol. Abiraterone was discontinued owing to abiraterone-induced adrenal insufficiency and hyperaldosteronism. Glucocorticoid supplementation was initiated. His symptoms soon improved, and the anti-hypertensives and potassium supplementation were discontinued. He was conscious and oriented during the remaining admission period. Conclusion: In conclusion, abiraterone alone induces secondary hypertension, and should be combined with corticosteroids to avoid possible adverse effects.
延伸閱讀
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