Endocrine Abstracts

Immunotherapies have been added to the arsenal for oncology treatment. They are useful in cancers which have metastasised including malignant melanoma, breast, lung and renal cancers. The endocrine consequences of checkpoint inhibitors include: Hypothyroidism; Graves’ disease; Hypophysitis; isolated ACTH deficiency; Type 1 diabetes (TID); and Primary Adrenal Insufficiency. The age of onset is approx. 61-66 yr and speed of onset is rapid. There is DKA at diagnosis in 50-76% of cases. There is undetectable C-peptide at diagnosis in 85% of cases. Positive antibody status at diagnosis is seen in 20-71% of patients. The three checkpoint inhibitors responsible for the development of diabetes are CTLA-4/PD-1/PI3K inhibitors. CTLA-4 (Cytotoxic T-lymphocyte associated protein 4) inhibitor: Ipilimumab (Yervoy). PD-1 (Programmed cell death protein 1) inhibitors: Pembrolizumab (Keytruda) and Nivolumab (Opdivo). P13K inhibitor Piqray (Alpelisib). It is the first approved for breast cancer treatment. We report 4 cases of T1D seen in 2019: 2 with DKA and two cases of diabetic ketosis without acidosis. PD-1 inhibitors compared to CTLA-4 inhibitors have higher prevalence of T1D. P13k inhibitor cause less endocrinopathies than both CTLA-4 and PD-1 inhibitors, but the prevalence of hyperglycaemia is about 51-64%. As a result of the cases above, we presented our findings to MDT, Day Care Oncology, Oncology ward, Pharmacy and Lunch and learn. A policy has been developed and all patients on these agents have lab glucose on each cycle, 3/12 HbA1c and are informed of the symptoms of hyperglycaemia: the 4 T’s. No acute episodes have arisen since.