scholarly journals Pembrolizumab-Induced Hypophysitis With Isolated Adrenocorticotropic Hormone (ACTH) Deficiency: A Rare Immune-Mediated Adverse Event

Cureus ◽  
2021 ◽  
Author(s):  
Andrew V Doodnauth ◽  
Miriam Klar ◽  
Yohannes S Mulatu ◽  
Zohra R Malik ◽  
Krunal H Patel ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adrenocorticotropic Hormone ◽  
Acth Deficiency ◽  
Immune Mediated

scholarly journals Clinical Responses to Rituximab in a Case of Neuroblastoma with Refractory Opsoclonus Myoclonus Ataxia Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Samin Alavi ◽  
Ali Kord Valeshabad ◽  
Borhan Moradveisi ◽  
Ali Aminasnafi ◽  
Mohammad Taghi Arzanian
Keyword(s):  
Eye Movements ◽  
Intravenous Immunoglobulin ◽  
Severity Score ◽  
Adrenocorticotropic Hormone ◽  
Efficacy And Safety ◽  
Imaging Studies ◽  
Immune Mediated ◽  
Clinical Responses ◽  
Ataxia Syndrome ◽  
Refractory Case

Opsoclonus myoclonus ataxia syndrome (OMS) is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient was a 3.5-year-old girl referred for ataxia and dancing eye movements starting since 1.5 years ago. She was diagnosed with neuroblastoma on imaging studies on admission. The OMS was refractory to surgical resection, chemotherapy, corticosteroids, and intravenous immunoglobulin. Patient received rituximab simultaneously with chemotherapy. The total severity score decreased by 61.1% after rituximab. Patient's ataxia markedly improved that she was able to walk independently after 6 months. Our case confirmed the clinical efficacy and safety of rituximab in a refractory case of OMS.

scholarly journals Thyroid Dysfunction in isolated Adrenocorticotropic Hormone (ACTH) Deficiency: Case Report and Literature Review.

1993 ◽  
Vol 40 (4) ◽  
pp. 473-478 ◽  
Author(s):  
TAKEHIKO MURAKAMI ◽  
SEIKI WADA ◽  
YASUYUKI KATAYAMA ◽  
YOKO NEMOTO ◽  
NOBUO KUGAI ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Adrenocorticotropic Hormone ◽  
Thyroid Dysfunction ◽  
Acth Deficiency

scholarly journals Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Masanori Murakami ◽  
Noriko Matsushita ◽  
Rie Arai ◽  
Naohiro Takahashi ◽  
Ryuki Kawamura ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Takotsubo Cardiomyopathy ◽  
Mental State ◽  
Adrenocorticotropic Hormone ◽  
Myocardial Dysfunction ◽  
Laboratory Data ◽  
Adrenal Crisis ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency

We report a 65-year-old woman with isolated adrenocorticotropic hormone (ACTH) deficiency. The patient was transported to the emergency outpatient department by ambulance complaining of malaise and nausea. Because her laboratory data revealed hyponatremia, we performed endocrinological examinations and diagnosed isolated ACTH deficiency. After admission, she went into a delirious state and suffered from takotsubo cardiomyopathy due to adrenal insufficiency. Replacement therapy with hydrocortisone sufficiently improved her delirium and cardiomyopathy. We conclude that her unstable mental state and myocardial dysfunction were closely related to adrenal insufficiency and suggest that adrenal crisis may cause delirium and Takotsubo cardiomyopathy.

scholarly journals MON-243 Atypical Presentation of Isolated Adrenocorticotropic Hormone Deficiency and Sheehan’s Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Zahira Marie Lugo López ◽  
Nadyeschka Angelique Rivera Santana ◽  
Andrea del Toro Diez ◽  
Michelle Marie Mangual Garcia ◽  
Ernesto Sola Sanchez ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Adrenocorticotropic Hormone ◽  
Brain Mri ◽  
Pituitary Hormones ◽  
Hormone Deficiency ◽  
Normal Brain ◽  
Sheehan’S Syndrome ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Sheehan's Syndrome

Abstract Introduction: Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare pituitary hormone deficiency defined by secondary adrenal insufficiency and normal secretion of all other pituitary hormones. Patients present with fatigue, weakness, weight loss, anorexia, nausea, low cortisol levels and low ACTH levels. Isolated ACTH deficiency is more common in males and usually presents in the fifth decade of life. Main mechanisms involved in the pathogenesis are genetics and autoimmune causes, traumatic brain injury and infarction of the pituitary postpartum, known as Sheehan’s syndrome. Sheehan’s syndrome is characterized by postpartum hemorrhage, failure to lactate and menstrual irregularities and it can occur from immediate postpartum period to years after delivery. The most common hormone deficiencies are prolactin and growth hormone. Empty sella is the most common finding on brain MRI. We are reporting a case of a woman in her third decade with isolated ACTH deficiency due to Sheehan’s syndrome two years postpartum, able to lactate, with normal menses and normal brain MRI. Clinical Case: A 33-year-old woman G3P3A0 with hypothyroidism who was referred to Endocrinology clinics due to tiredness, fatigue and weakness. She reported postpartum hemorrhage requiring 4 PRBC transfusions and IV steroids after last pregnancy 5 years ago. Patient was able to lactate after pregnancy and continued in her usual state of health until 3 years ago when she referred loss of consciousness with traumatic head injury due to hypoglycemia. At Endocrinology office physical examination and vital signs were unremarkable, including no blood pressure or heart rate variations with positional changes. Despite hypothyroidism being adequately controlled, she continued with extreme fatigue and weakness affecting her quality of life, for which cortisol and ACTH levels were ordered. Laboratories showed normal electrolytes, negative autoantibodies, cortisol 0.20 μg/dL (5-25 μg/dL) and ACTH 22 pg/mL (10-60 pg/mL) suggesting partial isolated ACTH deficiency. ACTH stimulation test was done and noted with suboptimal response. Evaluation of other anterior pituitary hormones was normal. Brain MRI showed normal pituitary gland. She was started on hydrocortisone in AM and PM and symptoms resolved. Conclusion: Immediate recognition of isolated ACTH deficiency due to Sheehan’s syndrome is necessary due to the availability of effective treatment and morbidity and mortality associated with this serious condition. To our knowledge isolated ACTH deficiency due to Sheehan’s syndrome in which the patient was able to lactate and normal findings on brain MRI has not previously been reported.References: Shivaprasad C. Sheehan’s Syndrome: Newer advances. Indian J Endocrinol Metab. 2011 Sep; 15(3): S203-207. DOI:10.4103/2230-8210.84869.

scholarly journals Immunotherapy-induced endocrinopathies: assessment, management and monitoring

2019 ◽  
Vol 10 ◽  
pp. 204201881989618 ◽  
Author(s):  
Edson Nogueira ◽  
Tom Newsom-Davis ◽  
Daniel L. Morganstein
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Mechanism Of Action ◽  
Checkpoint Inhibitors ◽  
Hormone Deficiency ◽  
High Dose ◽  
Multiple Organs ◽  
Immune Mediated

Immunotherapy with checkpoint inhibitors has transformed the treatment of cancer, but frequently results in immune-mediated adverse events affecting multiple organs, amongst which endocrine adverse events are frequent. The patterns of endocrine adverse events differ between inhibitors of the CTLA-4 and PD-1/PD-L1 pathways, but most frequently involve the thyroid and pituitary with insulin deficient diabetes also emerging as an important adverse event. These frequently result in long-lasting hormone deficiency requiring replacement. This review explores the mechanism of action of checkpoint inhibitors and details the expected endocrine adverse events and typical presentations. The effect of high-dose glucocorticoids therapy to treat nonendocrine adverse events is also discussed.

An Immune-Mediated Adverse Event Potentially Related to Rituximab

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alojzija Hočevar ◽  
Armin Alibegović ◽  
Vesna Jurčić ◽  
Matija Tomšič ◽  
Žiga Rotar
Keyword(s):  
Adverse Event ◽  
Immune Mediated

Ketotic Hypoglycemia and Hypopituitarism

PEDIATRICS ◽  
1979 ◽  
Vol 63 (3) ◽  
pp. 414-415
Author(s):  
William B. Lorentz
Keyword(s):  
Amino Acids ◽  
Growth Hormone ◽  
Short Stature ◽  
Adrenocorticotropic Hormone ◽  
Serum Levels ◽  
Pituitary Function ◽  
Acth Deficiency ◽  
Ketotic Hypoglycemia ◽  
Gluconeogenic Substrate

A 5-year-old girl had hypoglycemia and was of short stature. Studies of pituitary function demonstrated combined growth hormone and adrenocorticotropic hormone (ACTH) deficiency. She was shown to have ketotic hypoglycemia. In contrast to patients previously reported with hypopituitarism and ketotic hypoglycemia, she had no deficiency of gluconeogenic substrate. Serum levels of alanine and other gluconeogenic amino acids were normal during fasting and hypoglycemia. These studies suggest that inadequate gluconeogenic precursors are not the cause of her ketotic hypoglycemia. Ketotic hypoglycemia in association with hypopituitarism may be secondary to multiple biochemical defects.

scholarly journals Patient with isolated adrenocorticotropic hormone (ACTH) deficiency who was depressive before glucocorticoid replacement, and exhibited stupor during continuous ACTH test

2011 ◽  
Vol 65 (5) ◽  
pp. 535-535 ◽  
Author(s):  
Masaki Miyasaka ◽  
Kazuyasu Kojima ◽  
Mutsuko Yasuda ◽  
Tomoatsu Oji ◽  
Fumiatsu Yakushiji ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Acth Test ◽  
Acth Deficiency

ISOLATED ADRENOCORTICOTROPIC HORMONE (ACTH) DEFICIENCY

1982 ◽  
Vol 32 (6) ◽  
pp. 1111-1120
Author(s):  
Kenji Matsuo ◽  
Kazuto Shigematsu ◽  
Hiroyuki Kusano ◽  
Masataka Kihara ◽  
Kioko Kawai ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Acth Deficiency
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