ECE2016 Eposter Presentations Adrenal cortex (to include Cushing's) (85 abstracts)
Ipilimumab immunotheraphy for advanced melanoma induced autoimmune adrenalitis
Julia Silva-Fernández 1 , Rafael Morales-Chamorro 2 , Francisco Javier Gómez-Alfonso 1 , Florentino Del Val-Zaballos 1 , Álvaro García-Manzanares-Vázquez de Agredos 1 , María López-Iglesias 1 , Rafael García-Ruiz 3 & Inés Gómez-García 1
1Endocrinology Department, La Mancha Centro Hospital, Alcázar de San Juan, Spain; 2Oncology Department, La Mancha Centro Hospital, Alcázar de San Juan, Spain; 3Neurology Department, La Mancha Centro Hospital, Alcázar de San Juan, Spain.
Introduction: Ipilimumab is a monoclonal antibody against the inhibitory CTLA-4 receptor expressed on T cells. It provokes an upregulation of the immune system. It is known to cause neuroendocrine disorders, such as hypophysitis, hyppothyroidism/thyroiditis and adrenal insufficiency. Althought it is stipulated that thyroid.stimulating hormone (TSH) levels should be evaluated before administration of each dose of ipilimumab as a screen for thyroid diyfunction, there is no requeriment for screening pituitary-adrenal biochemistries.
Case report: A 68 year-old woman presented to Emergency Department with extreme fatigue (2 months of progressively worsening fatigue which provoked her visit to general doctor) and hyponatremia after receiving 4 doses of ipilimumab for metastatic melanoma (three months ago). Elevated ACTH levels, low morning cortisol levels along with failed to repond to cosyntropin stimulation test demonstrated primary adrenal insufficiency. Computed tomography scan of the abdomen showed bilateral enlargement of adrenal glands with metastatic desease in the right one. She was started on replacement dose of hydorcortisona with resolution of symptoms.
Conclusions: We recommend monitoring ACTH and cortisol levels in patients receiving ipilimumab therapy, similar to the routine screening thyroid function tests done to screen for hypothyroidism/thyroiditis, which is less frequent and sympomatic compared with adrenal insufficiency. CT findings of enlarged adrenal glands afther ipilimumab therapy should raise the suspición of drug-induced adrenalitis and may imply a monitoring of the patient’s adrenal function.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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