Abstract | BACKGROUND: CASE PRESENTATION: A 70-year-old Thai man with no previous history of diabetes mellitus was diagnosed with stage IVB non-small cell lung with pleural and liver metastases. After 14 weeks of combination treatment with pembrolizumab and ipilimumab, he presented with fatigue, nausea, and vomiting. Laboratory investigation revealed random plasma glucose 794 mg/dl, serum ketone 6.3 mmol/L, bicarbonate 13 mmol/L, and high anion gap 24 mmol/L. New-onset diabetes mellitus and diabetic ketoacidosis were diagnosed. Insulin therapy was initiated a favorable outcome within 10 hours. Despite improvement of hyperglycemia, the patient had persistent nausea and hyponatremia. Further investigation revealed cortisol 0.8 μg/dl and adrenocorticotropic hormone 21.7 pg/ml. His other pituitary hormone levels were normal, except for mild elevation of gonadotropin hormone. Magnetic resonance imaging of the pituitary showed a normal pituitary gland. Isolated adrenocorticotropic hormone deficiency was diagnosed, and corticosteroid replacement therapy was administered, resulting in an improvement of his symptoms. CONCLUSION:
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Authors | Thachanun Porntharukchareon, Borwonkhun Tontivuthikul, Nattaya Sintawichai, Panudda Srichomkwun |
Journal | Journal of medical case reports
(J Med Case Rep)
Vol. 14
Issue 1
Pg. 171
(Sep 29 2020)
ISSN: 1752-1947 [Electronic] England |
PMID | 32988414
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antibodies, Monoclonal, Humanized
- Ipilimumab
- Adrenocorticotropic Hormone
- pembrolizumab
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Topics |
- Adrenal Insufficiency
- Adrenocorticotropic Hormone
- Aged
- Antibodies, Monoclonal, Humanized
- Diabetic Ketoacidosis
(chemically induced)
- Humans
- Ipilimumab
(adverse effects)
- Male
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