Endocrine Abstracts

Introduction: Immune-checkpoint inhibitors (ICIs) have revolutionised cancer treatment, offering superior efficacy compared to traditional chemotherapy. The use of immune checkpoint inhibitors has been associated with the occurrence of multiple endocrine immune-related adverse events (irAEs), such as primary hypothyroidism, thyroiditis, primary adrenal insufficiency, type 1 diabetes mellitus, and hypophysitis. In certain instances, these irAEs may necessitate the discontinuation of treatment.

Case Report: We present a 50-year-old female patient with a history of multinodular goiter and previously treated Graves’ disease who was diagnosed with malignant melanoma in 2020. Immune checkpoint blockade therapy was initiated using anti-PD-1 antibodies and anti-CTLA-4. Within 2 months, the patient developed multiple immune-related endocrine complications. Clinical evaluation and laboratory investigations revealed autoimmune thyroiditis with elevated thyroid peroxidase antibodies (TPO), resulting in hypothyroidism requiring levothyroxine substitution (50 mg/day). Additionally, the patient was diagnosed with type 1 diabetes and autoimmune hepatitis. Subsequently, she presented with symptoms like asthenia, significant weight loss, hypotension, loss of appetite, nausea, and vomiting, leading to the diagnosis of primary adrenal insufficiency. Corticosteroid treatment was initiated.

Conclusions: This case highlights the importance of monitoring patients undergoing immune checkpoint blockade therapy for the emergence of immune-related endocrine complications. Routine assessment of hormone levels and pre-treatment baseline evaluations are crucial for timely intervention. Prompt intervention and appropriate therapeutic approaches successfully controlled the patient’s immune-related endocrine adverse events, allowing the continuation of immune checkpoint blockade therapy for melanoma.