Central diabetes insipidus related to anti-programmed cell-death 1 protein active immunotherapy.
We report a 71-years-old male patient with advanced lung cancer who experienced severe chronic hypernatremia presented as alterations in mental status five months after initiation of treatment with the anti-PD-1 checkpoint inhibitor nivolumab. Combination of persistenthypernatremia, polyuria, high plasma osmolality and hyposthenuria raised suspicion of diabetes insipidus, prompting measurement of serum concentration of arginine vasopressin(AVP). The inappropriately undetectable serum levels of AVP confirmed central diabetes insipidus (CDI). Nivolumab-related hypophysitis was recognized as possible cause of CDI. Further hormonal assessment excluded any endocrinopathy indicating disorder of posterior pituitary. Pituitary MRI was normal with persistence of hyperintensity of posterior pituitary on T1-weighted images (bright spot). The patient was scheduled to receive 1-deamino-8-D-arginine vasopressin (DDAVP), but he died suddenly due to cardiac arrest before initiation of treatment. Our report describes the first case of nivolumab related CDI, building on existing literature through: (I) underscoring hypovolemic hypernatremia as CDI manifestation; (ii) bringing into spotlight the rare anti-PD-1 treatment related hypophysitis; (iii) enriching the limited evidence on immune-related CDI. Increased awareness of nivolumab related CDI will enable prompt recognition and therapeutic intervention. PMID: 32244049 [PubMed - as supplied by publisher]
Publication date: Available online 22 May 2020Source: EXPLOREAuthor(s): Pritha Mehra, Bindu Sharma, Hafeezulla Baig, Ch. Raveendar, R.V.R. Prasad, M.Prakash Rao, Kolli Raju, J.S. Arya, Raj K. Manachanda, Daisy Katarmal, Arvind Kumar
Publication date: May 2020Source: Chinese Journal of Natural Medicines, Volume 18, Issue 5Author(s): Xue-Ying LI, Homng TAO, Can JIN, Zhen-Yun DU, Wen-Feng LIAO, Qing-Jiu TANG, Kan DING
Publication date: July–August 2020Source: Reports of Practical Oncology &Radiotherapy, Volume 25, Issue 4Author(s): Fabio Marazzi, Valeria Masiello, Gianluca Franceschini, Silvia Bosello, Francesca Moschella, Daniela Smaniotto, Stefano Luzi, Antonino Mulé, Maria Antonietta Gambacorta, Elisa Gremese, Riccardo Masetti, Vincenzo Valentini
Publication date: July–August 2020Source: Reports of Practical Oncology &Radiotherapy, Volume 25, Issue 4Author(s): John M. Watkins, J. Kyle Russo, Nicholas Andresen, Coyt R. Rountree, Amir Zahra, Sarah L. Mott, Daniel J. Herr, Jacy O’Keefe, Bryan G. Allen, Anand K. Sharma, John M. Buatti
Publication date: Available online 22 May 2020Source: Reports of Practical Oncology &RadiotherapyAuthor(s): Giandomenico Roviello, Benedetta Panella
Publication date: Available online 22 May 2020Source: Seminars in Cancer BiologyAuthor(s): Prisca Bustamante, Léo Piquet, Solange Landreville, Julia V. Burnier
Burman P Abstract OBJECTIVE: To investigate the contemporary presentation of pituitary metastases. PATIENTS: Thirty-eight patients diagnosed with pituitary metastases 1996 to 2018 in Sweden. METHODS: Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely due to radiological findings, including rapid tumor progression (n = 11). Medical charts were reviewed and sellar images re-examined centrally. RESULTS: Breast and lung cancer were the most common primary tumors, 45% and 21% of the patients. The pituitary was the only metastatic site in 9 patients. 67% of the bre...
We present a case of nephrogenic diabetes insipidus without severely reduced kidney function and propose a mechanism for the isolated finding. Severe hypernatremia can lead to encephalopathy and osmotic demyelination, and our report highlights the importance of careful monitoring of electrolytes and kidney function in patients with lung cancer receiving pemetrexed.
Conclusion: Clinicians should be aware of malignancies that are well known to metastasize to the posterior pituitary. Conversely, since not every patient presents with symptoms of metastasis, there is a need to recognize the clinical syndromes (e. g., diabetes insipidus-like symptoms or more subtle symptoms like cranial nerve palsies) associated with potential metastasis to the pituitary.
CONCLUSIONS At the time of this writing, approximately 60% (120/201) of PMs had been treated by stereotactic radiation therapy in Japan. The median survival time was much longer than that reported in past series. To confirm the changes of clinical features and medical practice, a prospective and population-based survey is mandatory. PMID: 26186025 [PubMed - as supplied by publisher]