Endocrine Abstracts

Background: Immunotherapy has become one of the standard interventions to treat various malignancies and auto-immune conditions with favourable responses to the treatment. However, the immune related adverse events of these medications are diverse which may include a variety of endocrinopathies, like Hypo cortisol, Hypophysitis, hypo and hyperthyroid states.

Case report: A 62 year old female with a background of Metastatic Malignant Melanoma on Combination Immunotherapy with Ipilimumab and Nivolumab (completed Immunotherapy First Cycle in June 2022, second cycle in 3rd Week of July 2022) attended routine phlebotomy clinic in end of July 2022 when she was found to be unwell. Patient had been muddled and extremely lethargic for 2 weeks, and also had complaints of anorexia, generalised fatigue and body pain for the same duration. Blood investigations revealed a low cortisol level of 102 and an in appropriately Low paired ACTH of < 5, low TSH (0.10) and T4 (10.8). The patient was immediately commenced on Hydrocortisone, treated with fluids. MRI of the pituitary revealed that the pituitary gland is not enlarged and enhances uniformly. The pituitary stalk is central with no abnormal enhancement. Patient improved clinically with the treatment and was discharged with Oral Hydrocortisone, and Hydrocortisone Emergency kit with a follow-up in the endocrine clinic, when patient was initiated on Fludrocortisone to manage her symptoms.

Conclusion: Immunotherapy related Endocrinopathies are being seen increasingly in clinical practise. It is seen most commonly in the first few months after initiating the treatment, and it is important for the clinicians involved in the patient care to monitor the patients receiving treatment closely with appropriate laboratory investigations which may include thyroid function tests, early morning cortisol levels along with regular follow-up after initiation of immunotherapy to promptly recognise any possible immunotherapy mediated endocrinopathies while patients are on Ipilimumab and Nivolumab.