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Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis

SUMMARY: A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presen...

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Autores principales: Fosci, Michele, Pigliaru, Francesca, Salcuni, Antonio Stefano, Ghiani, Massimo, Cherchi, Maria Valeria, Calia, Maria Antonietta, Loviselli, Andrea, Velluzzi, Fernanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849457/
https://www.ncbi.nlm.nih.gov/pubmed/33522491
http://dx.doi.org/10.1530/EDM-20-0123
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author Fosci, Michele
Pigliaru, Francesca
Salcuni, Antonio Stefano
Ghiani, Massimo
Cherchi, Maria Valeria
Calia, Maria Antonietta
Loviselli, Andrea
Velluzzi, Fernanda
author_facet Fosci, Michele
Pigliaru, Francesca
Salcuni, Antonio Stefano
Ghiani, Massimo
Cherchi, Maria Valeria
Calia, Maria Antonietta
Loviselli, Andrea
Velluzzi, Fernanda
author_sort Fosci, Michele
collection PubMed
description SUMMARY: A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibulo-neurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted. LEARNING POINTS: A remarkable risk of endocrine immune-related adverse events (irAEs) during therapy with checkpoint inhibitors exsists. In order to ensure maximum efficiency in the recognition and treatment of endocrine iRAes related to immune checkpoint inhibitors, multidisciplinary management of oncological patients is critical. . The pituitary syndrome in oncological patients who underwent immunotherapy represents a challenge in the differential diagnosis between pituitary metastasis and drug-induced hypophysitis. This is the first case, described in the literature of diabetes insipidus in a patient suffering from nivolumab-induced infundibulo-neurohypophysitis and anterohypophyseal metastasis.
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spelling pubmed-78494572021-02-03 Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis Fosci, Michele Pigliaru, Francesca Salcuni, Antonio Stefano Ghiani, Massimo Cherchi, Maria Valeria Calia, Maria Antonietta Loviselli, Andrea Velluzzi, Fernanda Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease SUMMARY: A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibulo-neurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted. LEARNING POINTS: A remarkable risk of endocrine immune-related adverse events (irAEs) during therapy with checkpoint inhibitors exsists. In order to ensure maximum efficiency in the recognition and treatment of endocrine iRAes related to immune checkpoint inhibitors, multidisciplinary management of oncological patients is critical. . The pituitary syndrome in oncological patients who underwent immunotherapy represents a challenge in the differential diagnosis between pituitary metastasis and drug-induced hypophysitis. This is the first case, described in the literature of diabetes insipidus in a patient suffering from nivolumab-induced infundibulo-neurohypophysitis and anterohypophyseal metastasis. Bioscientifica Ltd 2021-01-27 /pmc/articles/PMC7849457/ /pubmed/33522491 http://dx.doi.org/10.1530/EDM-20-0123 Text en © 2021 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Fosci, Michele
Pigliaru, Francesca
Salcuni, Antonio Stefano
Ghiani, Massimo
Cherchi, Maria Valeria
Calia, Maria Antonietta
Loviselli, Andrea
Velluzzi, Fernanda
Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title_full Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title_fullStr Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title_full_unstemmed Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title_short Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
title_sort diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849457/
https://www.ncbi.nlm.nih.gov/pubmed/33522491
http://dx.doi.org/10.1530/EDM-20-0123
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