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Hypopituitarism and Ipilimumab, an Uncommon Disease, Uncommon Cause

Yasar A. Ahmed, Kyle Taheny

Abstract


Background: Ipilimumab, a human monoclonal antibody that blocks cytotoxic T-Lymphocyte antigen CTLA-4 has demonstrated activity in patients with advanced (unresectable or metastatic) malignant melanoma. Up to 60% of patients treated with Ipilimumab develop immune-related adverse effects, usually occurring in the first twelve weeks. However, we present a case of hypopituitarism presenting over two months following final treatment with Ipilimumab, without radiological or clinical evidence of pituitary enlargement.

Case presentation: A 70 year old woman with a history of metastatic melanoma presented two months following complete response to treatment with Ipilimumab. She complained of increasing fatigue, extreme weakness, somnolence and confusion. Initial laboratory results revealed hyponatraemia and hypothyroidism.

Conclusions: While immune-related adverse effects are found in the majority of patients treated with Ipilimumab and cases of hypopituitarism are well documented, these are usually not acute and tend to progress sub-clinically. The onset of hypopituitarism observed in this patient, bearing in mind the lack of clinical and radiological evidence of pituitary enlargement, suggests that the auto-immune response induced by the anti-CTLA- 4 may additionally lead to clinical presentation even after a period from treatment cessation, without any clinically evident acute phase of inflammation. This may reflect the development of pituitary directed antibodies. Thus, we present a case of a previously unseen presentation of hypopituitarism secondary to Ipilimumab which will aid in its’ diagnosis and management.


Keywords


melanoma; ipilimumab; hypopitutarism

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References


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