Endocrine Abstracts

Programmed cell death-1 (PD-1) receptor inhibitor is an immune check point blockade for anticancer treatment and is currently used for various malignancies such as melanoma, non-small cell lung cancer, and so on. However, an immune check point blockade is associated with a risk for immune related adverse events. Among these events, Type 1 diabetes is rare. We present a case of a 52-year-old man, with no previously diabetic history, who developed diabetic ketoacidosis (DKA) after 10 doses of nivolumab for non-small cell lung cancer. One week after the 10th nivolumab therapy, he visited the emergency room because he had severe nausea and vomiting and was diagnosed DKA. He had a glycemia of 616 mg/dl, and arterial blood gas values showed a pH of 6.982 and very low bicarbonate. After continuous IV insulin and hydration, glucose level and acidosis was normalized. Further testing showed C peptide level was 0.26 ng/ml, insulin antibody was 7.18% (normal range ≤ 7%) and glutamic acid decarboxylase antibody was 0.13 U/ml (normal range 0–1.00 U/ml). Basal bolus multiple daily injections were started for glycaemic control. In addition, thyroid function was changed from thyrotoxicosis to overt hypothyroidism suggesting he had thyroiditis. One month later, he restarted nivolumab treatment with multiple insulin injections without any additional adverse events.

Physicians are becoming more aware of immune adverse event because the treatment using immune check point is increasing. Therefore, blood glucose monitoring during PD-1 inhibitor is necessary to avoid diabetic ketoacidosis