Endocrine Abstracts

A 66-year-old patient was diagnosed with lung cancer. In the interview, smoking for 40 years, about 20 cigarettes/day. Due to the intensifying cough, an x-ray of the chest was performed, a large tumor (12 cm) of the mediastinum and the right cavity was found. In the histopathological examination squamous cell carcinoma. Stage T4 N2 M0. Due to tumor inoperability, the patient was qualified for sequential chemo-radiotherapy. He received 3 cycles of chemotherapy (navelbin and cisplatin). After the chemotherapy, the lesion decreased to 6 cm, but it still infiltrated the division of the right and intermediate bronchi, and was still adjacent to the division of the right pulmonary artery and superior vena cava. Radiotherapy was used, however, in the control chest CT the dissemination of the disease was described: new changes appeared in the right lung apex up to 2.5 cm. In view of the progression of the disease, it was decided to take another type of treatment. The patient was referred to a center where immunotherapy is used. The histopathological block was examined again, immunological tests were performed. Tumor receptors have been shown to be present. The patient was qualified for anti-PD1 immunotherapy. Drug treatment brought excellent results. The lesion significantly decreased, peripheral lesions in the right lung disappeared. However, autoimmune hypothyroidism has emerged and requires levothyroxine therapy. Adrenal function remained normal. Treatment tolerance was very good. After a year of using immunotherapy, there was a significant weakness and decrease in muscle strength. The patient left home only for short walks, even clothing caused significant fatigue. It was difficult for the patient to raise their arms. Shortness of breath appeared, breathing air into the lungs was a big effort. The reason for the weakness was not adrenal insufficiency or pneumonia. Myasthenia gravis was suspected because of eyelid drooping and speech silence. Anti-acetylcholinesterase antibodies were determined. Their presence confirmed the diagnosis of myasthenia gravis. Pyridostigmine (acetylcholinesterase inhibitor) therapy was initiated. No ANA antinuclear antibodies or myositis panel antibodies were detected. Significant improvement in the patient’s condition was achieved after initiating pyridostigmine treatment. The drug was used in a dose of 60 mg every 4 hours. The patient is in a very good general condition, he is continuing immunotherapy.