Endocrine Abstracts

Introduction: In the last few years new imunomodulatory drugs are used for the treatment of metastatic melanoma. One of these drugs is ipilimumab, a monoclonal antibody that activates the immune system by targeting CTLA-4 protein receptor. This monoclonal antibody is very effective but there is a higher risk of endocrinopathies like an adverse effect of treatment, mostly hypophysitis and hypothyroidism.

Case: We present a 68-year-old patient with metastatic melanoma after four cycles of ipilimumab treatment. She was admitted for malaise, headache, nausea and vomiting. In the laboratory results hypocorticalism was diagnosed (cortisol lower than 28 nmol/l) with normal ACTH (12.7 ng/l). Administration of corticosteroids was started with an immediate effect and after 3 days MR of hypophysis was performed with a normal result. Nine months after hypophysitis the patient is still on corticosteroids.

Conclusion: Ipilimumab is a very effective CTLA-4 inhibitor that prolongs survival in patients with metatstatic melanoma. In the literature cases of hypophysitis were described as an adverse effect of treatment. That is why during therapy they are necessary regular controls of pituitary hormones. In case of hypophysitis high-dose corticosteroids should be given.