scholarly journals A Case of Isolated Adrenocorticotropic Hormone Deficiency Caused by Pembrolizumab

2020 ◽  
Vol 13 (1) ◽  
pp. 200-206 ◽  
Author(s):  
Tomoaki Bekki ◽  
Yuji Takakura ◽  
Masatoshi Kochi ◽  
Yoko Konemori ◽  
Kenji Oki ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Peritoneal Dissemination ◽  
Laboratory Data ◽  
Hormone Deficiency ◽  
Endocrine Disorders ◽  
Metastatic Colon Cancer ◽  
Contrast Enhanced ◽  
History Of ◽  
Isolated Adrenocorticotropic Hormone Deficiency ◽  
Enhanced Computed Tomography

Pembrolizumab (Keytruda®) is an anti-programmed cell death 1-specific monoclonal antibody that has become the standard second-line chemotherapy for unresectable advanced microsatellite instability-high colorectal cancer. Several immune-related adverse events (irAEs), particularly endocrinopathy, are linked to the administration of pembrolizumab. We report here a case of pembrolizumab-induced isolated adrenocorticotropic hormone deficiency in a patient with metastatic colon cancer. A 65-year-old woman visited our hospital for complaints of fatigue with a recent history of primary resection of cecal mucinous cancer and hepatectomy for liver metastasis 3 years ago. Peritoneal dissemination was detected 2 years after surgery. Several chemotherapeutic regimens of cytotoxic and molecular targeted drugs were administered; however, the metastases progressed gradually. Pembrolizumab monotherapy was started because of resistance to treatment. After 2 cycles of pembrolizumab, the patient was severely fatigued. Laboratory data demonstrated that the cortisol level was extremely low. All the other values were within the normal range. Magnetic resonance imaging indicated no mass in the pituitary gland. From multiple tolerance tests, we diagnosed isolated adrenocorticotropic hormone deficiency caused by pembrolizumab. The patient’s symptoms improved promptly with cortisol treatment. An abdominal contrast-enhanced computed tomography scan after 5 cycles of pembrolizumab demonstrated that the size of the peritoneal dissemination remained unchanged. However, her serum level of carcinoembryonic antigen had decreased to normal levels. Endocrine disorders are very rarely seen as irAEs. Careful laboratory data follow-up is required to inhibit the progression of severe endocrine disorders.

scholarly journals Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma

2021 ◽  
Vol 14 (7) ◽  
pp. e243093
Author(s):  
Koichi Hata ◽  
Chikara Sakaguchi ◽  
Michiko Tsuchiya ◽  
Yukio Nagasaka
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Adrenal Insufficiency ◽  
Malignant Mesothelioma ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Initial Symptom ◽  
Isolated Acth Deficiency ◽  
Wide Range ◽  
Isolated Adrenocorticotropic Hormone Deficiency

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

2021 ◽  
Vol 14 (12) ◽  
pp. e245024
Author(s):  
Ajay Chikara ◽  
Sasidhar Reddy Karnati ◽  
Kailash Chand Kurdia ◽  
Yashwant Sakaray
Keyword(s):  
Abdominal Pain ◽  
Stable Condition ◽  
Paraduodenal Hernia ◽  
Inferior Mesenteric Vein ◽  
Anterior Border ◽  
Initial Reduction ◽  
Contrast Enhanced ◽  
History Of ◽  
Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

Intraductal Papillary Mucinous Neoplasm of the Pancreas

2021 ◽  
Vol 8 (28) ◽  
pp. 2562-2566
Author(s):  
Jayalatha Nethagani ◽  
Priyanka Govula ◽  
Revathi Chandu ◽  
Pravin Raj T
Keyword(s):  
Epigastric Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
Cystic Lesions ◽  
Chronic Alcoholic ◽  
Contrast Enhanced ◽  
History Of ◽  
Head Of The Pancreas ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 36-year-old non-smoker, chronic alcoholic female presented with recurrent episodes of epigastric pain and vomiting in the last 10 days. H/o similar episodes of pain 3 times, with last episode was noted 2 months back. She also had history of vomiting (3 episodes). Jaundice/melena/steatorrheas was not observed. Subsequently, contrast-enhanced computed tomography (CECT) of the patient was done and it showed well defined multiple cystic lesions with peripheral wall enhancement involving head and body of pancreas, largest measuring 24 X 22 X 22 mm in the head of the pancreas, the lesion was seen abutting antro-pyloric region anteriorly. Main pancreatic is mildly dilated measuring 4 mm in diameter. A well-defined heterogeneously hypodense (necrotic) para duodenal lesion, was noted inferior to uncinate process, m/s 22 X 20 X 20 mm, which is indicative of lymph nodal deposit. On magnetic resonance cholangiopancreatography (MRCP): few cystic lesions were seen scattered in the pancreatic parenchyma, with one of the cysts showing communication with main pancreatic duct (MPD) ab.

scholarly journals Late-onset isolated adrenocorticotropic hormone deficiency caused by nivolumab: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ayumu Takeno ◽  
Masahiro Yamamoto ◽  
Miwa Morita ◽  
Sayuri Tanaka ◽  
Ippei Kanazawa ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenocorticotropic Hormone ◽  
Late Onset ◽  
Hormone Deficiency ◽  
Isolated Adrenocorticotropic Hormone Deficiency

scholarly journals Isolated adrenocorticotropic hormone deficiency development during chemotherapy for gastric cancer: a case report

2014 ◽  
Vol 8 (1) ◽  
Author(s):  
Jun Kinoshita ◽  
Shinnosuke Higashino ◽  
Sachio Fushida ◽  
Katsunobu Oyama ◽  
Toshifumi Watanabe ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Case Report ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Isolated Adrenocorticotropic Hormone Deficiency

Isolated adrenocorticotropic hormone deficiency as a form of paraneoplastic syndrome

Pituitary ◽  
2018 ◽  
Vol 21 (5) ◽  
pp. 480-489 ◽  
Author(s):  
Hironori Bando ◽  
Genzo Iguchi ◽  
Keitaro Kanie ◽  
Hitoshi Nishizawa ◽  
Ryusaku Matsumoto ◽  
...  
Keyword(s):  
Paraneoplastic Syndrome ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Isolated Adrenocorticotropic Hormone Deficiency

scholarly journals Mediastinal Pseudocyst and Cardiac Tamponade Due to Massive Pericardial Effusion in Pediatric Chronic Calcific Pancreatitis

2016 ◽  
Vol 06 (03) ◽  
pp. 194-198 ◽  
Author(s):  
Suprit Basu ◽  
Mala Bhatacharya ◽  
Bidyut Debnath ◽  
Sandip Sen ◽  
Anish Chatterjee ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pancreatic Enzyme ◽  
Recurrent Abdominal Pain ◽  
Chronic Calcific Pancreatitis ◽  
Contrast Enhanced ◽  
History Of ◽  
Posterior Mediastinal ◽  
Enhanced Computed Tomography

AbstractA 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

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