Case Report: Multiple Endocrine Insufficiency Secondary to the use of CTLA-4 Inhibitors for the Treatment of Subungual Melanoma

Abstract

The case of a 60-year-old woman diagnosed with subungual melanoma who received treatment with ipilimumab for 7 sessions and amputation of the first finger of her left hand and who presented multiple glandular damage is presented. The adverse effects associated with antineoplastic therapy induced by inhibition of the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) checkpoints occur in approximately 0.5-10.5% hypophysitis as the main affectation, adrenalitis, alterations in gonadal hormones and thyroid stimulating hormone 91%, 84% and 83%, respectively. With overall survival of 21.4 months in those who developed hypophysitis compared to 9.7 months in those who did not develop it. Some other disorders with a lower proportion are diabetes mellitus due to insulin deficiency, hyponatremia and diabetic ketoacids. In this case, diabetes mellitus occurred due to insulin deficiency with diabetic ketoacids related to thyrotoxicosis, being a rare presentation. We consider that this case is of interest and useful for the initiation of therapy, as well as for follow-up, through thyroid profile, measurement of cortisol, ACTH, insulin, ovarian profile, prolactin and vasopressin, as well as MRI, in order to rule out prevention or treatment. the adverse effects related and reducing the mortality mentioned in the literature.