Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report

  • Authors:
    • Nobuki Furubayashi
    • Takahito Negishi
    • Tomoharu Uozumi
    • Dai Takamatsu
    • Koichi Shiraishi
    • Daisuke Hirose
    • Motonobu Nakamura
  • View Affiliations

  • Published online on: November 30, 2018     https://doi.org/10.3892/mco.2018.1781
  • Pages: 304-308
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Abstract

Nivolumab is a monoclonal immunoglobulin G antibody blocking programmed death receptor‑1 (PD‑1) that promotes the restoration of the natural T‑cell‑mediated immune response against cancer cells; however, it also causes a number of autoimmune‑related adverse events (irAEs) that often involve the endocrine system. The present report describes a 71‑year‑old man with clear cell renal cell carcinoma metastasis in the lung. Following the 14th course of nivolumab therapy, the patient complained of general malaise, loss of appetite and mild consciousness disturbance. Laboratory tests revealed a severely elevated eosinophil ratio (26.2%) and low sodium value (122 mmol/l). Endocrine system tests revealed that the patient's adrenocorticotropic hormone (ACTH; 4.5 pg/ml) and cortisol (0.1 µg/dl) levels were lower than normal, while those of other pituitary hormones were higher than normal. This case was therefore diagnosed as isolated ACTH deficiency induced by nivolumab. Magnetic resonance imaging (MRI) showed normal pituitary glands. Hydrocortisone replacement therapy improved the clinical symptoms early and enabled the patient to restart nivolumab therapy. Isolated ACTH deficiency due to nivolumab, a PD‑1 immune checkpoint inhibitor antibody, is a rare occurrence. This report may be useful for avoiding delays in the diagnosis and treatment of this life‑threatening irAE even if no pituitary abnormalities are identified via MRI.
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February-2019
Volume 10 Issue 2

Print ISSN: 2049-9450
Online ISSN:2049-9469

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Spandidos Publications style
Furubayashi N, Negishi T, Uozumi T, Takamatsu D, Shiraishi K, Hirose D and Nakamura M: Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report. Mol Clin Oncol 10: 304-308, 2019
APA
Furubayashi, N., Negishi, T., Uozumi, T., Takamatsu, D., Shiraishi, K., Hirose, D., & Nakamura, M. (2019). Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report. Molecular and Clinical Oncology, 10, 304-308. https://doi.org/10.3892/mco.2018.1781
MLA
Furubayashi, N., Negishi, T., Uozumi, T., Takamatsu, D., Shiraishi, K., Hirose, D., Nakamura, M."Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report". Molecular and Clinical Oncology 10.2 (2019): 304-308.
Chicago
Furubayashi, N., Negishi, T., Uozumi, T., Takamatsu, D., Shiraishi, K., Hirose, D., Nakamura, M."Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report". Molecular and Clinical Oncology 10, no. 2 (2019): 304-308. https://doi.org/10.3892/mco.2018.1781