Bexarotene and Hypopituitarism

ABSTRACT Objective: Bexarotene is currently approved for treatment of cutaneous T-cell lymphoma and is also under investigation for other cancers such as lung, breast, and thyroid cancer. We recently reported a patient with mycosis fungoides treated with bexarotene. The treatment induced hypopituitarism characterized by hypogonadism, hypothyroidism, and hypoadrenalism, which had not been previously reported. Methods: Here we report a second case with the same features and emphasize the possible risk of adrenal insufficiency during bexarotene treatment. Results: A 59 year-old male patient was diagnosed with anaplastic lymphoma. He was treated with 6 cycles of chemotherapy and interferon alfa 2b in the first 2 years of his treatment. Later, bexarotene treatment was initiated because lymphoma progression was observed. The patient developed hypopituitarism characterized by hypogonadism, hypothyroidism, and hypoadrenalism 2 months after bexarotene therapy. Conclusions: Clinicians should have a high index of suspicion for hypopituitarism, especially adrenal failure, in patients under bexarotene therapy. Patients’ cortisol levels should be monitored, especially in those who develop suggestive symptoms. In addition, we suggest that bexarotene could be evaluated as a potential therapy for Cushing disease. Abbreviations: CT computed tomography GH growth hormone TSH thyroid-stimulating hormone