A Case of Autoimmune Hypophysitis Induced by Ipilimumab/Nivolumab Combination Therapy for Metastatic Melanoma
Year: 2023
Type: article
Abstract: Ipilimumab and Nivolumab are immune checkpoint inhibitors used to treat patients with advanced melanoma to improve survival.However, they are commonly associated with immune-related adverse events, including endocrinopathies, colitis, dermatitis, and hepatitis.Here, we report a case of Autoimmune hypophysitis Induced by ipilimumab/nivolumab Combination Therapy, which is an increasingly recognised phenomenon.Prior to symptom onset, the patient's hormonal profile already suggested hypophysitis following initiation of ipilimumab/nivolumab, with a low thyroxine level and an inappropriately normal thyroid stimulating hormone level.The clinician was falsely reassured by a morning cortisol level within normal range, without performing low dose short synacthen test.Therefore, the diagnosis of hypophysitis was delayed.This case report serves as a reminder to suspect, diagnose, and treat immune checkpoint inhibitor Induced hypophysitis promptly, as the resulting hormonal insufficiency can be life-threatening. Case historyAn 83-year-old Chinese gentleman presented to the Accident and Emergency department in July 2021 for severe non-vertigo dizziness and fatigue.He is an ex-smoker and ex-drinker, with a past medical history of pulmonary tuberculosis in 2009.10 months prior to presentation, in September 2020, he was diagnosed with BRAF-negative metastatic melanoma of scrotum with groin and external iliac lymph node metastasis.He was treated with 4 cycles of intravenous (IV) nivolumab 480mg every 4 weeks, an immune checkpoint inhibitor (ICPi), between November 2020 and February 2021.Routine thyroid function tests (TFTs) in January 2021 showed a secondary hypothyroid pattern, evidenced by a low free thyroxine (FT4) level of 10.8 pmol/L and an inappropriately normal thyroid stimulating hormone (TSH) level of 3.28 mIU/L.(Table 1) Anti-thyroglobulin and anti-thyroid peroxidase antibody levels were normal.Morning cortisol level was 160nmol/L, which was within normal range.The
Author: Cheuk Cheung Derek Leung
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4372049985