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Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis

Autoimmune diabetes is a rare but severe endocrine toxicity induced by immune checkpoint inhibitor (ICI) treatment. It is unclear if ICI causes selective islet toxicity or non-selective pancreas toxicity. We analyzed 11 patients treated with ICI who developed ICI-related autoimmune diabetes. Eight p...

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Autores principales: Zhang, Amy L., Wang, Fang, Chang, Lee-Shing, McDonnell, Marie E., Min, Le
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076788/
https://www.ncbi.nlm.nih.gov/pubmed/33927691
http://dx.doi.org/10.3389/fendo.2021.620522
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author Zhang, Amy L.
Wang, Fang
Chang, Lee-Shing
McDonnell, Marie E.
Min, Le
author_facet Zhang, Amy L.
Wang, Fang
Chang, Lee-Shing
McDonnell, Marie E.
Min, Le
author_sort Zhang, Amy L.
collection PubMed
description Autoimmune diabetes is a rare but severe endocrine toxicity induced by immune checkpoint inhibitor (ICI) treatment. It is unclear if ICI causes selective islet toxicity or non-selective pancreas toxicity. We analyzed 11 patients treated with ICI who developed ICI-related autoimmune diabetes. Eight patients had lipase and/or amylase tested on the same day of diagnosis of autoimmune diabetes. Among them, 75% (6/8) had normal lipase and 100% (6/6) had normal amylase. There was no correlation between glucose level at onset and biochemical pancreatitis. We characterized the clinical features of ICI-induced autoimmune diabetes. Fifty-five percent (6/11) of patients tested positive for GAD65 autoantibodies, and 55% (6/11) developed diabetic ketoacidosis at manifestation of hyperglycemia. In all 11 patients, C-peptide levels were low in the presence of hyperglycemia. ICI-induced thyroiditis was found in 64% (7/11), of which 36% (4/11) were newly diagnosed with thyroiditis while the remaining 27% (3/11) had pre-existing hypothyroidism followed by ICI-induced thyroiditis. Additionally, 27% (3/11), developed ICI-induced hypophysitis. Thyroiditis and autoimmune diabetes coexisted in all patients with ICI-induced hypophysitis. The median time from ICI treatment to the onset of autoimmune diabetes was 11 weeks. Our data suggest that few patients had coexistent ICI-induced autoimmune diabetes and pancreatitis, suggesting ICI mainly caused selective islet toxicity.
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spelling pubmed-80767882021-04-28 Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis Zhang, Amy L. Wang, Fang Chang, Lee-Shing McDonnell, Marie E. Min, Le Front Endocrinol (Lausanne) Endocrinology Autoimmune diabetes is a rare but severe endocrine toxicity induced by immune checkpoint inhibitor (ICI) treatment. It is unclear if ICI causes selective islet toxicity or non-selective pancreas toxicity. We analyzed 11 patients treated with ICI who developed ICI-related autoimmune diabetes. Eight patients had lipase and/or amylase tested on the same day of diagnosis of autoimmune diabetes. Among them, 75% (6/8) had normal lipase and 100% (6/6) had normal amylase. There was no correlation between glucose level at onset and biochemical pancreatitis. We characterized the clinical features of ICI-induced autoimmune diabetes. Fifty-five percent (6/11) of patients tested positive for GAD65 autoantibodies, and 55% (6/11) developed diabetic ketoacidosis at manifestation of hyperglycemia. In all 11 patients, C-peptide levels were low in the presence of hyperglycemia. ICI-induced thyroiditis was found in 64% (7/11), of which 36% (4/11) were newly diagnosed with thyroiditis while the remaining 27% (3/11) had pre-existing hypothyroidism followed by ICI-induced thyroiditis. Additionally, 27% (3/11), developed ICI-induced hypophysitis. Thyroiditis and autoimmune diabetes coexisted in all patients with ICI-induced hypophysitis. The median time from ICI treatment to the onset of autoimmune diabetes was 11 weeks. Our data suggest that few patients had coexistent ICI-induced autoimmune diabetes and pancreatitis, suggesting ICI mainly caused selective islet toxicity. Frontiers Media S.A. 2021-04-13 /pmc/articles/PMC8076788/ /pubmed/33927691 http://dx.doi.org/10.3389/fendo.2021.620522 Text en Copyright © 2021 Zhang, Wang, Chang, McDonnell and Min https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Zhang, Amy L.
Wang, Fang
Chang, Lee-Shing
McDonnell, Marie E.
Min, Le
Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title_full Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title_fullStr Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title_full_unstemmed Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title_short Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis
title_sort coexistence of immune checkpoint inhibitor-induced autoimmune diabetes and pancreatitis
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076788/
https://www.ncbi.nlm.nih.gov/pubmed/33927691
http://dx.doi.org/10.3389/fendo.2021.620522
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