Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma

BMJ Case Rep. 2021 Jul 21;14(7):e243093. doi: 10.1136/bcr-2021-243093.

Abstract

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

Keywords: Endocrine system; Pituitary disorders; Respiratory cancer.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / chemically induced
  • Adrenocorticotropic Hormone
  • Aged, 80 and over
  • Endocrine System Diseases*
  • Female
  • Humans
  • Mesothelioma, Malignant*
  • Nivolumab / adverse effects

Substances

  • Nivolumab
  • Adrenocorticotropic Hormone