ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)
Immunotherapy-induced Endocrinopathy: A Case Report
Ben Ali Khaoula , Loukil Fatma , Busieau Pauline , Potier Louis , Marion Camoin , Hanen Bouaziz , Hasanain Al Mukh , Aurelie Carlier & Jean François Gautier
Bichat Claude Bernad Hospital, Endocrinology, Diabetology and Nutrition, Paris, France
Introduction: Immunotherapy is an effective therapeutic choice increasingly prescribed in oncology. Endocrine toxicity is described among its side effects.
Methods: A case of a patient treated with immunotherapy since January 2022 is hospitalized in the endocrinology department in Bichat Hospital.
Results: Mr K, aged 46, treated with of anti-CTA4 and anti-PD1 inhibitors for melanoma. A month after the treatment the findings showed an acute adrenal insufficiency with a cortisol level at 14.9 nmol/l. An intravenous hydrocortisone treatment was initiated then relay orally. Besides, a Peripheral hyperthyroidism was noted (TSH was undetectable with FT4 at 3.5 N) secondary to Hashitoxicosis with anti TG and anti TPO antibodies at >10N, cervical ultrasound was normal. We opted for therapeutic abstention in view of the absence of clinical signs of hyperthyroidism. Prolactinemia was slightly elevated justifying the realization of MRI pituitary which was normal. The Control at 2 months showed: a cortisol at 584.9 nmol / L and ACTH at 22.7 pmol / l, the synacthen test showed the persistence of peripheral adrenal insufficiency with cortisol at T0 at 230 nmol /l, T60 at 261 nmol/l and AC TH at 50pmol/l hence the maintenance of hydrocortisone. Passage into peripheral hypothyroidism with TSH at 10N hence the treatment with Levothyroxine.
Conclusion: this case illustrates the possibility of occurrence of peripheral adrenal insufficiency under immunotherapy (less described in the literature than central involvement) justifying clinical and biological monitoring of the corticotropic axis throughout the duration of treatment with immunotherapy.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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