Endocrine Abstracts

Introduction: We are presenting a case of presumed ipilimumab induced hypophysitis, after completion of 4th cycle of Ipilimumab for stage 4 melanoma.

Case Report: A 72-year-old gentleman diagnosed with stage 4 melanoma, Presented with generalised joint pain and fatigue after 4th cycle of ipilimumab, he had short synacthen test, baseline serum cortisol was <30 nmol/l, 30 min cortisol 379 nmol/l, he was started hydrocortisone therapy 10 mg in the morning, 5 mg at lunch, 5 mg in the evening.

His thyroid function at that time showed TSH <0.1 mU/l, with free T₄ of 10.7 pmol/l, and a free T₃ of 4.2 pmol/l. He had a normal prolactin, and low testosterone at 0.6 nmol/l. He underwent MRI of pituitary which showed normal appearance of pituitary gland, stalks and optic chiasm.

Discussion: Ipilimumab is a human monoclonal antibody that has been shown to overcome the suppressive effects of cytotoxic T lymphocyte Antigen 4 expression, thereby enhancing the immune response against tumours. It is used in the treatment of metastatic melanoma. Side effects include hypophysitis, colitis, uveitis, dermatitis and arthritis among others.