title: A Rare Case of Sunitinib-Induced Hyperammonemic Encephalopathy and Hypothyroidism in Metastatic Renal Cell Carcinoma.
abstract: Sunitinib has become a standard treatment agent for metastatic renal cell carcinoma (RCC) for several years. However, various adverse events have been reported. We present a rare adverse effect of hyperammonemic encephalopathy induced by sunitinib. A 66-year-old woman with metastatic RCC referred to the emergency department with confusion that developed 14 days after the initiation of 50 mg/d of sunitinib. Her serum ammonia and thyroid-stimulating hormone levels were markedly elevated (146 μg/dL and 27.27 μIU/mL, respectively). Sunitinib was discontinued, and an enema with lactulose and L-thyroxine were administered. Her mental status and neurologic symptoms were normalized 7 days after the treatment. Serum ammonia level decreased to 61 μg/dL and thyroid stimulating hormone level decreased 22.34 μIU/mL. The incidence of sunitinib-induced hyperammonemia is rarely reported. The relationship between sunitinib and the development of hyperammonemia is not well understood, and the mechanism is unclear. Sunitinib-induced hyperammonemia is very rare, and to the best of our knowledge, this is fourth case hyperammonemia and first case hyperammonemic encephalopathy with hypothyroidism as an adverse effect. Therefore, it is important for clinicians to be aware of hyperammonemia that can occur in several days after the initiation of sunitinib treatment in metastatic RCC.
authors.affiliation: 1Department of Medical Oncology, Faculty of Medicine, Bilim University, Istanbul, Turkey; Departments of 2Radiology, 3Medical Oncology, and 4General Surgery, Gayrettepe Florence Nightingale Hospital, Besiktas, Turkey; and 5Department of Pathology, Acıbadem Hospital, Istanbul, Turkey.
authors.forename: Kezban Nur
authors.initials: KN
authors.lastname: Pilanc
authors.forename: Filiz
authors.initials: F
authors.lastname: Elbüken
authors.forename: Çetin
authors.initials: Ç
authors.lastname: Ordu
authors.forename: Gülistan
authors.initials: G
authors.lastname: Köksal
authors.forename: Mehmet Hakan
authors.initials: MH
authors.lastname: Tekelioğlu
authors.forename: Kerem
authors.initials: K
authors.lastname: Okutur
authors.forename: Süha
authors.initials: S
authors.lastname: Göksel
authors.forename: Ülkühan
authors.initials: Ü
authors.lastname: Köksal
authors.forename: Tark
authors.initials: T
authors.lastname: Akçal
authors.forename: Coşkun
authors.initials: C
authors.lastname: Tecimer
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced*; D007037:Hypothyroidism / Q000139:chemically induced*; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011758:Pyrroles / Q000009:adverse effects*; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib