Pregnancy and delivery in an advanced cancer survivor with immune checkpoint inhibitor-induced type 1 diabetes: a case report.

Autor: Sugai K; Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan., Miwa T; Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan., Kojima J; Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan., Ueda Y; Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan., Tsukahara K; Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan., Nishi H; Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan., Suzuki R; Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan. suzukir@tokyo-med.ac.jp.
Jazyk: angličtina
Zdroj: Endocrine [Endocrine] 2024 Aug; Vol. 85 (2), pp. 593-597. Date of Electronic Publication: 2024 Mar 19.
DOI: 10.1007/s12020-024-03780-w
Abstrakt: Purpose: Given the rarity and elderly onset of immune checkpoint inhibitor (ICI)-induced type 1 diabetes (ICI-T1DM), cases leading to delivery are rare.
Method: To our knowledge, this is the first case report of childbirth in a patient with ICI-T1DM after cancer survival. A 32-year-old woman was started on Nivolumab for metastatic parotid cancers one year after total parotidectomy.
Result: The patient developed ICI-T1DM after 43 cycles and started multiple daily insulin therapy and self-monitoring of blood glucose. Complete response was maintained for 2 years by nivolumab, and she finished nivolumab in 77 cycles to attempt pregnancy. During the follow-up period, she began using a sensor-augmented pump (SAP). She had undetectable serum and urinary C-peptide when she started SAP. Her HbA1c level decreased from 7.8 to 6.6% without increasing hypoglycemia in one year. The patient remained in complete response after ICI discontinuation, and embryo transfer was initiated. Pregnancy was confirmed after a second embryo transfer (21 months after ICI discontinuation). At 36 weeks and 6 days, an emergency cesarean section was performed due to the onset of preeclampsia. The baby had hypospadias and bifid scrotum but no other complications or neonatal intensive care unit admission.
Conclusion: Because ICI discontinuation and ICI-T1DM carry risks for the patient and child, the decision regarding pregnancy warrants careful consideration. Diabetologists should collaborate with patients and other clinical departments to develop a treatment plan for childbirth.
(© 2024. The Author(s).)
Databáze: MEDLINE
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