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A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma
Patient: Female, 50 Final Diagnosis: Adrenal insufficiency Symptoms: Appetite loss • severe fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic OBJECTIVE: Unusual clinical course BACKGROUND: Ipilimumab is a therapeutic human monoclonal antibody that targets the T-cell...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354724/ https://www.ncbi.nlm.nih.gov/pubmed/30679413 http://dx.doi.org/10.12659/AJCR.913021 |
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author | Sakaguchi, Chihiro Yano, Seiichi Ashida, Kenji Wada, Naoko Ohe, Kenji Nagata, Hiromi Matsuda, Yayoi Sakamoto, Shohei Sakamoto, Ryuichi Ohnaka, Keizo Uchi, Hiroshi Furue, Masutaka Nomura, Masatoshi Ogawa, Yoshihiro |
author_facet | Sakaguchi, Chihiro Yano, Seiichi Ashida, Kenji Wada, Naoko Ohe, Kenji Nagata, Hiromi Matsuda, Yayoi Sakamoto, Shohei Sakamoto, Ryuichi Ohnaka, Keizo Uchi, Hiroshi Furue, Masutaka Nomura, Masatoshi Ogawa, Yoshihiro |
author_sort | Sakaguchi, Chihiro |
collection | PubMed |
description | Patient: Female, 50 Final Diagnosis: Adrenal insufficiency Symptoms: Appetite loss • severe fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic OBJECTIVE: Unusual clinical course BACKGROUND: Ipilimumab is a therapeutic human monoclonal antibody that targets the T-cell inhibitory molecule, cytotoxic T-lymphocyte antigen-4 (CTLA-4), and is classified as an immune checkpoint inhibitor that has been shown to improve prognosis in patients with advanced melanoma. However, several immune-related adverse events have been reported to be associated with ipilimumab Treatment. A case of acute exacerbation of chronic adrenal insufficiency is presented that highlights that glucocorticoid dosage for patients undergoing steroid treatment at the time of ipilimumab treatment has yet to be established. CASE REPORT: A 50-year-old Japanese woman was diagnosed with malignant melanoma on the sole of her right foot. During her second course of ipilimumab treatment, she developed acute adrenal insufficiency caused by isolated adrenocorticotropic hormone (ACTH) deficiency, which required treatment with oral hydrocortisone. However, the symptoms of her adrenal insufficiency worsened, and she commenced treatment with 12 courses of nivolumab, a therapeutic human monoclonal antibody that blocks programmed cell death protein 1 (PD-1) on the surface of T-cells. She did not require corticosteroid support during nivolumab treatment. CONCLUSIONS: This case report highlights the risk of exacerbating adrenal insufficiency during treatment with ipilimumab. The differences in clinical outcome in this patient between ipilimumab and nivolumab treatment might be explained by the different mechanisms between ipilimumab and nivolumab on immune function. |
format | Online Article Text |
id | pubmed-6354724 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-63547242019-02-15 A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma Sakaguchi, Chihiro Yano, Seiichi Ashida, Kenji Wada, Naoko Ohe, Kenji Nagata, Hiromi Matsuda, Yayoi Sakamoto, Shohei Sakamoto, Ryuichi Ohnaka, Keizo Uchi, Hiroshi Furue, Masutaka Nomura, Masatoshi Ogawa, Yoshihiro Am J Case Rep Articles Patient: Female, 50 Final Diagnosis: Adrenal insufficiency Symptoms: Appetite loss • severe fatigue Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic OBJECTIVE: Unusual clinical course BACKGROUND: Ipilimumab is a therapeutic human monoclonal antibody that targets the T-cell inhibitory molecule, cytotoxic T-lymphocyte antigen-4 (CTLA-4), and is classified as an immune checkpoint inhibitor that has been shown to improve prognosis in patients with advanced melanoma. However, several immune-related adverse events have been reported to be associated with ipilimumab Treatment. A case of acute exacerbation of chronic adrenal insufficiency is presented that highlights that glucocorticoid dosage for patients undergoing steroid treatment at the time of ipilimumab treatment has yet to be established. CASE REPORT: A 50-year-old Japanese woman was diagnosed with malignant melanoma on the sole of her right foot. During her second course of ipilimumab treatment, she developed acute adrenal insufficiency caused by isolated adrenocorticotropic hormone (ACTH) deficiency, which required treatment with oral hydrocortisone. However, the symptoms of her adrenal insufficiency worsened, and she commenced treatment with 12 courses of nivolumab, a therapeutic human monoclonal antibody that blocks programmed cell death protein 1 (PD-1) on the surface of T-cells. She did not require corticosteroid support during nivolumab treatment. CONCLUSIONS: This case report highlights the risk of exacerbating adrenal insufficiency during treatment with ipilimumab. The differences in clinical outcome in this patient between ipilimumab and nivolumab treatment might be explained by the different mechanisms between ipilimumab and nivolumab on immune function. International Scientific Literature, Inc. 2019-01-25 /pmc/articles/PMC6354724/ /pubmed/30679413 http://dx.doi.org/10.12659/AJCR.913021 Text en © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Sakaguchi, Chihiro Yano, Seiichi Ashida, Kenji Wada, Naoko Ohe, Kenji Nagata, Hiromi Matsuda, Yayoi Sakamoto, Shohei Sakamoto, Ryuichi Ohnaka, Keizo Uchi, Hiroshi Furue, Masutaka Nomura, Masatoshi Ogawa, Yoshihiro A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title | A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title_full | A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title_fullStr | A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title_full_unstemmed | A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title_short | A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma |
title_sort | case of acute exacerbation of chronic adrenal insufficiency due to ipilimumab treatment for advanced melanoma |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354724/ https://www.ncbi.nlm.nih.gov/pubmed/30679413 http://dx.doi.org/10.12659/AJCR.913021 |
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