Keywords
hypophysitis
adrenalitis
immunotherapy
sella turcica
How to Cite
Abstract
Introduction: Checkpoint inhibitors have revolutionized the treatment of cancer patients, increasing disease-free survival; These are therapies with endorsement for the management of solid neoplasms. Among the adverse events are those at the level of the endocrine system. We report the case of a patient treated with anti CTLA-4 and anti PD-1 who developed hypophysitis and adrenalitis.
Objective: To describe the case of a patient who presented endocrinopathies (hypophysitis and adrenalitis) associated with the use of immunotherapy, in a clinic in the city of Medellin, Colombia.
Case presentation: 74-year-old woman with a history of renal cell carcinoma, treated with ipilimumab and nivolumab, that were suspended due to pneumonitis. Three months later, she presented to the emergency department due to decreased functional class and drowsiness. On physical examination with hypotension. Hypotonic hyponatremia, and low basal cortisol were evidenced. A pituitary profile was requested, finding low somatomedin, low Follicle-stimulating hormone (FSH) and high adrenocorticotropic hormone (ACTH). MRI of the sella turcica showed absence of structural alterations. Hypophysitis with a normal image and primary adrenal insufficiency secondary to adrenalitis was concluded.
Discussion and conclusions: Immune checkpoint inhibitors are drugs currently used for different types of neoplasms, these drugs are associated in a significant percentage with endocrinopathies, however, finding the simultaneous involvement of two endocrine glands is unusual, being this the second reported case in the literature with hypophysitis and adrenalitis.
The clinical manifestations of endocrinopathies associated with immunotherapy should be recognized, considering the increasing use of these therapies for different neoplasms. The involvement of more than one endocrine gland is uncommon, however it should be suspected and recognized. It is important to establish in each center a protocol for the approach and follow-up of these patients.
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