Endocrine Abstracts

Introduction: Ipilimumab is an efficient medication used for the management of melanoma. However, it has been associated with endocrine dysfunctions such as hypophysitis, thyroid disorders (hypo- or hyperthyroidism), and adrenal insufficiency.

Case report: We report the case of a 65-year-old male diagnosed with melanoma (Clark V). In 2022, he was operated and received treatment with ipilimumab 3 mg/kg. Three weeks after the first administration, he presented in the Emergency Department with hypotension, nausea, extreme tiredness. Further investigation revealed a low cortisol level of 0.2 mg/dl and ACTH below 1.5 pg/ml. Based on the findings, the patient was diagnosed with adrenal insufficiency secondary to immunotherapy-associated hypophysitis, and treatment with IV glucocorticoids was immediately started, with rapid improvement of the symptomatology. The thyroid tests showed a TSH level of 0.7 mUI/ml, slightly increased ft4 levels of 2.04 ng/dl, positive ATPO, and antithyroglobulin antibodies. However, he had no signs of hyperthyroidism, and anti TSH receptor antibodies (TRAb) level came 0.8 UI/l (N<1.7), so silent thyroiditis was assumed. The other tests showed both low testosterone and GH levels, no optic chiasm compression and normal MRI of the pituitary. Upon discharge, he was prescribed continued replacement therapy with glucocorticoids and beta-blockers in case of increased heart rate.

Conclusion: Endocrine dysfunctions can occur at varying points during treatment with ipilimumab, so monitoring and early detection are essential in these cases.