Isolated Adrenocorticotropin Deficiency due to Nivolumab-induced Hypophysitis in a Patient with Advanced Lung Adenocarcinoma: A Case Report and Literature Review

Nobumasa Ohara; Kazumasa Ohashi; Toshiya Fujisaki; Chiyumi Oda; Yohei Ikeda; Yuichiro Yoneoka; Takehisa Hashimoto; Go Hasegawa; Kazuo Suzuki; Toshinori Takada

doi:10.2169/internalmedicine.9074-17

CASE REPORTS

Isolated Adrenocorticotropin Deficiency due to Nivolumab-induced Hypophysitis in a Patient with Advanced Lung Adenocarcinoma: A Case Report and Literature Review

Nobumasa Ohara, Kazumasa Ohashi, Toshiya Fujisaki, Chiyumi Oda, Yohei Ikeda, Yuichiro Yoneoka, Takehisa Hashimoto, Go Hasegawa, Kazuo Suzuki, Toshinori Takada

Author information

Nobumasa Ohara
Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Kazumasa Ohashi
Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Toshiya Fujisaki
Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Chiyumi Oda
Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Yohei Ikeda
Department of Radiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Yuichiro Yoneoka
Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Takehisa Hashimoto
Department of Thoracic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Go Hasegawa
Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Kazuo Suzuki
Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
Toshinori Takada
Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan

Keywords: hypophysitis, nivolumab, lung adenocarcinoma, hydrocortisone, human leukocyte antigen

JOURNAL OPEN ACCESS

2018 Volume 57 Issue 4 Pages 527-535

DOI https://doi.org/10.2169/internalmedicine.9074-17

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Abstract

A 63-year-old Japanese woman with advanced lung adenocarcinoma developed isolated adrenocorticotropin deficiency caused by immune checkpoint inhibitor (ICI)-related hypophysitis following 8 months of nivolumab therapy. Prompt corticosteroid replacement therapy effectively relieved her secondary adrenal insufficiency symptoms and allowed her to pursue nivolumab therapy, which had been effective for the control of lung adenocarcinoma. Human leukocyte antigen (HLA) typing revealed the presence of the DRB1*04:05-DQA1*03:03-DQB1*04:01 haplotype, which is associated with susceptibility to autoimmune polyglandular syndrome with pituitary disorder in the Japanese population. This case suggests that genetic factors, such as HLA, contribute to the development of endocrinopathies induced by ICIs.

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