Abdominal Pain As an Initial Symptom of Isolated ACTH Deficiency Induced by Nivolumab in a Patient with Malignant Mesothelioma

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2021 Jul 22

PMID 34290022

Authors

Koichi Hata

Chikara Sakaguchi

Michiko Tsuchiya

Yukio Nagasaka

Affiliations

Soon will be listed here.

Abstract

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

References

Arnason J, Graziano F . Adrenal insufficiency in the antiphospholipid antibody syndrome. Semin Arthritis Rheum. 1995; 25(2):109-16. DOI: 10.1016/s0049-0172(95)80024-7. View

Bleicken B, Hahner S, Ventz M, Quinkler M . Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients. Am J Med Sci. 2010; 339(6):525-31. DOI: 10.1097/MAJ.0b013e3181db6b7a. View

Pierrard J, Petit B, Lejeune S, Seront E . Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab. BMJ Case Rep. 2019; 12(8). PMC: 6720815. DOI: 10.1136/bcr-2019-230848. View

Takebayashi K, Ujiie A, Kubo M, Furukawa S, Yamauchi M, Shinozaki H . Isolated Adrenocorticotropic Hormone Deficiency and Severe Hypercalcemia After Destructive Thyroiditis in a Patient on Nivolumab Therapy With a Malignant Melanoma. J Clin Med Res. 2018; 10(4):358-362. PMC: 5827922. DOI: 10.14740/jocmr3257w. View

Takaya K, Sonoda M, Fuchigami A, Hiyoshi T . Isolated Adrenocorticotropic Hormone Deficiency Caused by Nivolumab in a Patient with Metastatic Lung Cancer. Intern Med. 2017; 56(18):2463-2469. PMC: 5643175. DOI: 10.2169/internalmedicine.8548-16. View

Takeno A, Yamamoto M, Morita M, Tanaka S, Kanazawa I, Yamauchi M . Late-onset isolated adrenocorticotropic hormone deficiency caused by nivolumab: a case report. BMC Endocr Disord. 2019; 19(1):25. PMC: 6381704. DOI: 10.1186/s12902-019-0335-x. View

Seki T, Yasuda A, Oki M, Kitajima N, Takagi A, Nakajima N . Secondary Adrenal Insufficiency Following Nivolumab Therapy in a Patient with Metastatic Renal Cell Carcinoma. Tokai J Exp Clin Med. 2017; 42(3):115-120. View

Jones R, Karthik F, Dugar A, Kanagarajan K, Desai K, Bhandari M . Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes. Am J Case Rep. 2018; 19:783-789. PMC: 6061454. DOI: 10.12659/AJCR.909584. View

Kitajima K, Ashida K, Wada N, Suetsugu R, Takeichi Y, Sakamoto S . Isolated ACTH deficiency probably induced by autoimmune-related mechanism evoked with nivolumab. Jpn J Clin Oncol. 2017; 47(5):463-466. DOI: 10.1093/jjco/hyx018. View

10.

de Filette J, Andreescu C, Cools F, Bravenboer B, Velkeniers B . A Systematic Review and Meta-Analysis of Endocrine-Related Adverse Events Associated with Immune Checkpoint Inhibitors. Horm Metab Res. 2019; 51(3):145-156. DOI: 10.1055/a-0843-3366. View

11.

Sznol M, Postow M, Davies M, Pavlick A, Plimack E, Shaheen M . Endocrine-related adverse events associated with immune checkpoint blockade and expert insights on their management. Cancer Treat Rev. 2017; 58:70-76. DOI: 10.1016/j.ctrv.2017.06.002. View

12.

Narahira A, Yanagi T, Cho K, Nakamura A, Miyoshi H, Hata H . Isolated adrenocorticotropic hormone deficiency associated with nivolumab therapy. J Dermatol. 2016; 44(4):e70. DOI: 10.1111/1346-8138.13571. View

13.

Espinosa G, Santos E, Cervera R, Piette J, de la Red G, Gil V . Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003; 82(2):106-18. DOI: 10.1097/00005792-200303000-00005. View

14.

Min L . Immune-related endocrine disorders in novel Immune checkpoint inhibition therapy. Genes Dis. 2018; 3(4):252-256. PMC: 5881952. DOI: 10.1016/j.gendis.2016.10.002. View

15.

Kitano S, Tatsuno K, Ishibe J, Shimauchi T, Fujiyama T, Ito T . Isolated Adrenocorticotropic Hormone Deficiency in Melanoma Patients Treated with Nivolumab. Acta Derm Venereol. 2018; 98(7):704-705. DOI: 10.2340/00015555-2902. View

16.

Ohara N, Ohashi K, Fujisaki T, Oda C, Ikeda Y, Yoneoka Y . Isolated Adrenocorticotropin Deficiency due to Nivolumab-induced Hypophysitis in a Patient with Advanced Lung Adenocarcinoma: A Case Report and Literature Review. Intern Med. 2017; 57(4):527-535. PMC: 5849549. DOI: 10.2169/internalmedicine.9074-17. View

17.

Okahata S, Sakamoto K, Mitsumatsu T, Kondo Y, Noso S, Ikegami H . Fulminant type 1 diabetes associated with Isolated ACTH deficiency induced by anti-programmed cell death 1 antibody-insight into the pathogenesis of autoimmune endocrinopathy. Endocr J. 2019; 66(4):295-300. DOI: 10.1507/endocrj.EJ18-0328. View

18.

Sato Y, Tanaka Y, Hino M, Seike M, Gemma A . A case of nivolumab-induced isolated adrenocorticotropic hormone (ACTH) deficiency. Respir Med Case Rep. 2019; 26:223-226. PMC: 6356048. DOI: 10.1016/j.rmcr.2019.01.021. View

19.

Kagoshima H, Hori R, Kojima T, Okanoue Y, Fujimura S, Taguchi A . Adrenal insufficiency following nivolumab therapy in patients with recurrent or metastatic head and neck cancer. Auris Nasus Larynx. 2019; 47(2):309-313. DOI: 10.1016/j.anl.2019.05.009. View

20.

Ohara N, Kobayashi M, Ohashi K, Ito R, Ikeda Y, Kawaguchi G . Isolated adrenocorticotropic hormone deficiency and thyroiditis associated with nivolumab therapy in a patient with advanced lung adenocarcinoma: a case report and review of the literature. J Med Case Rep. 2019; 13(1):88. PMC: 6434613. DOI: 10.1186/s13256-019-2002-2. View