Document Detail


Association of ipilimumab therapy for advanced melanoma with secondary adrenal insufficiency: a case series.
MedLine Citation:
PMID:  22138079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To present a case series of ipilimumab-related secondary adrenal insufficiency.
METHODS: In this cases series, we review the presentation, evaluation, diagnosis, and management of patients with advanced melanoma who received ipilimumab and were referred to our endocrinology clinic for evaluation of hormonal abnormalities.
RESULTS: Seven patients presented with symptoms, signs, or biochemical evidence of adrenal insufficiency 6 to 12 weeks after starting ipilimumab therapy. Ipilimumab is a cytotoxic T-lymphocyte antigen 4 (CTLA-4) monoclonal antibody that is approved for the treatment of metastatic melanoma and has widespread use for this disease. All 7 patients had biochemical evidence of profound secondary adrenal insufficiency. Thyroid function abnormalities, central hypogonadism, and low insulinlike growth factor 1 levels were seen in a subset of patients. Only 2 patients had abnormal findings on pituitary magnetic resonance imaging. Posterior pituitary function remained normal.
CONCLUSIONS: Our findings suggest that the enhanced immune response associated with ipilimumab therapy may have a predilection for corticotroph and possibly thyrotroph cells. We recommend periodic hypothalamic-pituitary-adrenal axis monitoring for patients on this therapy.
Authors:
Le Min; Anand Vaidya; Carolyn Becker
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  18     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:    2012 May-Jun
Date Detail:
Created Date:  2012-05-17     Completed Date:  2012-09-14     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  351-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adrenal Insufficiency / chemically induced*,  physiopathology
Adult
Aged
Antibodies, Monoclonal / adverse effects*,  therapeutic use
Antineoplastic Agents / adverse effects*,  therapeutic use
CTLA-4 Antigen / antagonists & inhibitors
Drug Monitoring
Female
Humans
Male
Melanoma / drug therapy*,  secondary
Middle Aged
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
F32 HL104776/HL/NHLBI NIH HHS; F32 HL104776-02/HL/NHLBI NIH HHS; K08 HD070957/HD/NICHD NIH HHS; T32 DK007529/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antineoplastic Agents; 0/CTLA-4 Antigen; 0/ipilimumab
Comments/Corrections

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