Primary hypothyroidism and isolated ACTH deficiency induced by nivolumab therapy: Case report and review

Medicine
Mei Fang ZengXiao Long Zhao

Abstract

Nivolumab is a monoclonal IgG antibody blocking programmed death receptor-1 (PD1), leading to restoration of the natural T-cell-mediated immune response against the cancer cells. However, it also causes plenty of autoimmune-related adverse events, which often involves endocrine system. A 54-year-old male with renal clear cell carcinoma was treated with nivolumab intravenously. Routine monitoring showed elevated thyroid-stimulating hormone and low free thyroxine after the 6th administration of nivolumab. After the 12th administration, he developed general fatigue, recurrent hypoglycemia, and relative hypotension. Laboratory tests showed low sodium, low morning cortisol without correspondence increase of corticotrophin (ACTH). Other pituitary hormones were normal. MRI showed no space-occupying lesions, but heterogeneous enhancement of the pituitary gland. Primary hypothyroidism and isolated ACTH deficiency. The etiologies were assumed to be nivolumab induced autoimmune lymphocytic thyroiditis and hypophysitis, respectively. Hormone replacements with levothyroxine and acetate cortisone were given orally. Nivolumab was adjusted to lower dose and longer interval. The patient felt good after adequate replacement. Nivolumab was return...Continue Reading

References

Jan 1, 1980·The Journal of Clinical Endocrinology and Metabolism·D J ToplissJ R Stockigt
Aug 13, 2003·Autoimmunity·Anna A Kasperlik-ZałuskaWłodzimierz Czech
Nov 2, 2006·Pituitary·Massimiliano AndrioliFrancesco Cavagnini
Dec 19, 2012·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Jeffrey R GarberUNKNOWN American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults
Jan 18, 2014·Autoimmunity Reviews·P CaturegliN R Rose
Mar 4, 2015·Endocrinology and Metabolism Clinics of North America·Hidenori Fukuoka
Oct 27, 2015·Pharmacotherapy·Ninh M La-BeckDevin B Lowe
May 15, 2016·The Journal of Dermatology·Masashi Ishikawa, Kohei Oashi
Nov 1, 2016·Endocrine Journal·Yudai OkanoMasanobu Yamada
Nov 5, 2016·The Journal of Clinical Endocrinology and Metabolism·Maria FleseriuMary H Samuels
Jan 21, 2017·Nature Reviews. Endocrinology·David J ByunMonica Girotra
Mar 16, 2017·The Journal of Dermatology·Tomoko OdaMotonobu Nakamura
Mar 28, 2017·Therapeutic Advances in Medical Oncology·Camille MazzaLaurence Albiges
May 26, 2017·Thyroid : Official Journal of the American Thyroid Association·Ichiro YamauchiNobuya Inagaki

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Citations

Aug 31, 2019·BMJ Case Reports·Catarina Martins MachadoMaria João Oliveira
Apr 30, 2020·Immunotherapy·Maria V DeligiorgiDimitrios T Trafalis
Feb 2, 2019·Frontiers in Endocrinology·Carmine IadarolaLuca Chiovato
Oct 18, 2020·Journal of Clinical Medicine·Manon LevyChristine Cugnet-Anceau
Aug 7, 2019·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Jason A WillisEduardo Vilar
Jan 5, 2021·Expert Opinion on Biological Therapy·Maria V DeligiorgiDimitrios T Trafalis
Mar 15, 2021·Clinical Journal of Gastroenterology·Tsutomu NamikawaKazuhiro Hanazaki
Mar 25, 2021·Pituitary·Pedro IglesiasJuan José Díez

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Methods Mentioned

BETA
hormone replacement therapy

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