Double the Battle: Two Cases of Irreversible Endocrinopathies in Patients Already Fighting Metastatic Cancer

Abstract Immune Checkpoint Inhibitors (ICI) have been approved since 2011 to treat patients with advanced solid and hematological malignancies had remarkable results. However, case reports of endocrine adverse events are becoming increasingly reported can be fatal if not recognized early. Here we present two unique cases rare endocrinopathies after the use ICIs. A 47 year old male metastatic melanoma presented nausea, vomiting, polyuria, polydipsia 5 days. Three weeks prior, he was started on nivolumab ipilimumab. On presentation, tachycardic tachypneic. Lab work for a glucose 676, Na 129, K 6.2, CO2 6, Cr 2.43 (baseline 1.1) beta-hydroxybutyrate 11.7 elevated HgA1c 7.1%. DKA diagnosed fluids insulin drip were started. Further up revealed normal cortisol level, TFTs C-peptide <1 consistent new-onset type I diabetes mellitus in setting ICI agents. Patient regimen. An 81 female bladder cancer Pembrolizumab admitted 2 fatigue, positional dizziness dyspnea. She recently hyperkalemia attributed dehydration. admission, she hypotensive blood pressure 81/59 heart rate no fever. dry mucous membranes exam but abnormal skin. an AM <1, ACTH 458 positive Cosyntropin stim test, primary adrenal insufficiency. CT-Abdomen Pelvis did reveal any acute masses. hydrocortisone at discharge fludrocortisone due hypotension. ICIs categorized as target programmed death-1 receptor inhibitors (PD-1) nivolumab, pembrolizumab, cemiplimab, death-ligand 1 (PDL1) atezolizumab, avelumab, durvalumab cytotoxic T-lymphocyte associated protein-4 (CTLA-4) iplimumab. checkpoint proteins T-cell surface receptors that cause inhibition when they bind their ligands limit immune response. Tumors manipulate these inhibitory pathways evade rejection. longer halt response result effective treatment. robust go attack healthy tissue resulting such hypophysitis, hypo-or hyperthyroidism, or Acute hypocortisolemia thyroid storm identified acutely. Current guidelines recommend baseline screening TFTs, morning monthly thereafter In this report, irreversible treated who developed These warn physicians vigilant consider possibility life-threatening endocrinopathies.