Open AccessOnset of fulminant type 1 diabetes mellitus following hypophysitis after discontinuation of combined immunotherapy. A case report
Author(s) -
Boswell Laura,
Casals Gregori,
Blanco Jesús,
Jiménez Amanda,
Aya Francisco,
Hollanda Ana,
Halperin Irene,
Arance Ana M,
Mora Mireia,
Hanzu Felicia A
Publication year - 2021
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13604
Subject(s) - medicine , ipilimumab , hypophysitis , fulminant , nivolumab , discontinuation , immunotherapy , type 1 diabetes , diabetes mellitus , immunology , pediatrics , cancer , endocrinology , hormone , pituitary gland
Diabetes is a rare, but potentially life‐threatening, adverse event of immune checkpoint inhibitors that requires prompt recognition and treatment. It usually occurs in the first 3 months of treatment and is typically related to programmed cell death‐1 antibodies, alone or in combined therapy. It has rarely been described developing after immunotherapy cessation. We present a 51‐year‐old man with metastatic melanoma, who developed acute‐onset diabetes 52 days after combined immunotherapy cessation with nivolumab and ipilimumab, and 25.6 months after receiving the first dose. He presented with acute hyperglycemic symptoms, ketosis, complete insulin depletion and negative autoimmunity, fulfilling the criteria of fulminant type 1 diabetes. The patient had previously developed hypophysitis with isolated adrenocorticotropic hormone deficiency during immunotherapy. We describe a case of late‐onset fulminant type 1 diabetes developing after immunotherapy cessation. Patient education and active follow up after immunotherapy discontinuation are crucial to warrant a timely intervention.