SFEBES2022 Poster Presentations Endocrine Cancer and Late Effects (14 abstracts)
Emergency Ambulatory Outpatient Management of Immune Checkpoint Inhibitor-mediated Hypocortisolaeamia
Shawg Ganawa 1,2 , Haris Muhammad 1,2 , Tom Knight 3,2 , Shaishav Dhage 1,2 , Jan Hoong Ho 1,2 , Avinash Gupta 4,2 , Paul Lorigan 4,2 , Claire Higham 1,2,5 , Tim Cooksley 3,2 & Safwaan Adam 1,2
1Department of Endocrinology, Manchester, United Kingdom; 2The Christie Hospital, Manchester, United Kingdom; 3Department of Acute Medicine and Critical Care, Manchester, United Kingdom; 4Department of Medical Oncology, Manchester, United Kingdom; 5Manchester Academic Health Science University of Manchester, Manchester, United Kingdom
Background: Immunotherapy mediated adrenocorticotrpic hormone (ACTH) deficiency is an important toxicity related to immune-checkpoint inhibitors (ICPi) potentially resulting in significant morbidity. Early diagnosis and optimal management are essential and frequently necessitate inpatient hospital treatment. We have previously reported an ambulatory management pathway for ICPi-induced ACTH deficiency in 4 patients. We sought to report the outcomes of this pathway in a larger cohort to validate its utility.
Methods: Patients presenting with clinical features and findings consistent with ICPi-induced hypocortisolaemia in the absence of severe features (sodium ≤125 mmol/l, hypotension, reduced consciousness, hypoglycaemia, visual field defects) have been managed using our ambulatory management pathway; briefly, suitable patients are administered a single intravenous dose of hydrocortisone (100 mg) and then observed for at least 4 hours and then discharged on oral hydrocortisone (20 mg, 10 mg, 10 mg) and an hydrocortisone emergency pack. Patients are then seen urgently in the endocrinology clinic for further assessment and management. We excluded patients with suspected adrenalitis, asymptomatic incidentally discovered hypocortisolaemia and with a history of exogenous glucocorticoid use.
Results: Thirteen patients (aged 40-79; 11 male) were managed using our pathway. All the patients had biochemically proven ACTH deficiency. The mean time from discharge to endocrinology outpatient follow-up was 8 days. There were no 30-day readmissions nor was there any associated hypocortisolaemia-related mortality. Every patient continued the ICPi therapy without interruption.
Conclusion: Our ambulatory care pathway has been utilised successfully to treat patients with ICPi-induced hypocortisolaemia. There was no observable adverse outcome related to its use and the adoption of this pathway for appropriate patients can potentially lead to reductions in hospital admissions, minimise interruptions to cancer care and enhance the patient experience.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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