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Case Reports
. 2022 Oct-Dec;18(4):516-522.
doi: 10.4183/aeb.2022.516.

NIVOLUMAB ASSOCIATED ENDOCRINE ABNORMALITIES: CHALLENGING CASES FROM A REFERENCE CLINIC

M C Unal  1 , G Güngör Semiz  1 , O Ozdoğan  2 , C Altay  3 , E Caliskan Yildirim  4 , H S Semiz  4 , A Comlekci  1 , B Akinci  1
Affiliations
Case Reports

NIVOLUMAB ASSOCIATED ENDOCRINE ABNORMALITIES: CHALLENGING CASES FROM A REFERENCE CLINIC

M C Unal et al. Acta Endocrinol (Buchar). 2022 Oct-Dec.

Abstract

Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced cancers. Antibodies directed against programmed cell death receptor 1 (PD-1) interrupt the ability of the cancerous cell to depress the immune system.

Methods and results: We report three patients who developed different endocrine abnormalities after treatment with nivolumab, a monoclonal antibody directed against PD-1. First, we report a 76-year-old male presenting with generalized fat loss after treatment with nivolumab which predominantly affected his face and trunk. Second, we described the development of thyroiditis that presented with thyrotoxicosis and the expression of thyroid-stimulating hormone receptor antibodies (TRAb). Finally, we observed the emergence of adrenal insufficiency due to hypophysitis in another case.

Conclusion: Although immune checkpoint inhibitors are an effective anticancer treatment modality, adverse effects are evident that can affect the endocrine system. These adverse events may relate to different endocrine systems that include the thyroid and pituitary glands. Also, acquired generalized lipodystrophy should be suspected in patients developing unusual fat loss after treatment with ICIs.

Keywords: Grave’s disease; adrenal insufficiency; hypophysitis; lipodystrophy; nivolumab; thyroiditis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Coronal (I) and transverse (II-VII) views of PET-CT (five months after the initiation of nivolumab) showing increased metabolic activity in subcutaneous fat compartments and intermuscular fat surrounding skeletal muscle in patient 1. PET-CT: Positron emission tomography–computed tomography.
Figure 2
Figure 2
A follow-up PET-CT images after discontinuation of nivolumab showing maintenance of increased metabolic activity associated in fat loss areas. PET-CT: Positron emission tomography–computed tomography.
Figure 3
Figure 3
The whole-body magnetic resonance imaging showing subcutaneous fat loss in a generalized pattern in patient 1 (A). Panel B shows normal fat distribution in a healthy man.(I), whole body, coronal T1-weighted imaging; (II), orbital fat and scalp, axial T1-weighted imaging; (III), shoulders, axial T1-weighted imaging; (IV), breasts, axial T1-weighted imaging; (V), external genital region and palms, axial T1-weighted imaging; (VI-VII), limbs, axial T1-weighted imaging.
Figure 4
Figure 4
[99mTc] pertechnetate thyroid scintigraphy showing reduced activity in an anterior view image.
See this image and copyright information in PMC

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