Simultaneous onset of type 1 diabetes mellitus and silent thyroiditis under durvalumab treatment
| Autor: | Laia Casamitjana Espuña, Ismael Capel, Assumpta Caixàs, Jose León Mengíbar, Mercedes Rigla, Isabel Mazarico, Teresa Bonfill |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Thyroiditis Durvalumab Xeroderma C-peptide (blood) endocrine system diseases pH (blood) Endocrinology Diabetes and Metabolism Levothyroxine White lcsh:Diseases of the endocrine glands. Clinical endocrinology Hyperthyroidism Gastroenterology Cortisol 0302 clinical medicine Diabetes mellitus type 1 Diabetic ketoacidosis Insulin Hyperglycaemia FT3 FT4 Myasthaenia Glucose (blood fasting) Fatigue biology TSH Diabetes Hyponatraemia Thyroid Nausea Autoimmune disorders Bicarbonate medicine.anatomical_structure Thyroid antibodies July 030220 oncology & carcinogenesis Thyroid function ACTH stimulation medicine.drug Adult CT scan endocrine system medicine.medical_specialty Insulin glargine Vomiting Thyroxine (T4) 030209 endocrinology & metabolism Glucose (blood) Dizziness 03 medical and health sciences Hyperkalaemia Hypothyroidism Bladder cancer GADA Thyroid peroxidase Fluid repletion Internal medicine Unusual Effects of Medical Treatment Internal Medicine medicine Polydipsia Polyphagia Pancreas Haemoglobin A1c Weight gain Insulin Aspart Type 1 diabetes lcsh:RC648-665 Anion gap Beta-hydroxybutyrate Triiodothyronine (T3) Polyuria business.industry medicine.disease Oedema Spain biology.protein business Constipation |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-4 (2019) |
| ISSN: | 2052-0573 |
| DOI: | 10.1530/edm-19-0045 |
| Popis: | Summary Durvalumab, a human immunoglobulin G1 kappa monoclonal antibody that blocks the interaction of programmed cell death ligand 1 (PD-L1) with the PD-1 and CD80 (B7.1) molecules, is increasingly used in advanced neoplasias. Durvalumab use is associated with increased immune-related adverse events. We report a case of a 55-year-old man who presented to our emergency room with hyperglycaemia after receiving durvalumab for urothelial high-grade non-muscle-invasive bladder cancer. On presentation, he had polyuria, polyphagia, nausea and vomiting, and laboratory test revealed diabetic ketoacidosis (DKA). Other than durvalumab, no precipitating factors were identified. Pre-durvalumab blood glucose was normal. The patient responded to treatment with intravenous fluids, insulin and electrolyte replacement. Simultaneously, he presented a thyroid hormone pattern that evolved in 10 weeks from subclinical hyperthyroidism (initially attributed to iodinated contrast used in a previous computerised tomography) to overt hyperthyroidism and then to severe primary hypothyroidism (TSH: 34.40 µU/mL, free thyroxine (FT4): Learning points: Patients treated with anti-PD-L1 should be screened for the most common immune-related adverse events (irAEs). Glucose levels and thyroid function should be monitored before and during the treatment. Durvalumab is mainly associated with thyroid and endocrine pancreas dysfunction. In the patients with significant autoimmune background, risk–benefit balance of antineoplastic immunotherapy should be accurately assessed. |
| Databáze: | OpenAIRE |
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