Nivolumab-induced hypophysitis leading to hypopituitarism and secondary empty sella syndrome in a patient with non-small cell lung cancer

BMJ Case Rep. 2019 Mar 7;12(3):e228135. doi: 10.1136/bcr-2018-228135.

Abstract

We describe the clinical course of a 64-year-old woman with stage IVa lung adenocarcinoma who presented with over 1 month of fatigue, unintentional weight loss and emesis. She initiated treatment with nivolumab immunotherapy 1 year prior and had been tolerating the treatment well. A comprehensive workup revealed multiple endocrinological abnormalities consistent with hypophysitis leading to hypopituitarism in the form of central adrenal insufficiency and hypogonadism as well as a partially empty sella on imaging. This case demonstrates that while receiving novel forms of treatment such as immunotherapy, patients should be monitored closely for a wide range of adverse effects.

Keywords: lung cancer (oncology); pituitary disorders; unwanted effects/adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung / pathology
  • Adrenal Insufficiency / complications
  • Anti-Inflammatory Agents / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / complications*
  • Empty Sella Syndrome / diagnostic imaging
  • Empty Sella Syndrome / etiology
  • Female
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / therapeutic use
  • Hypophysitis / chemically induced*
  • Hypophysitis / complications
  • Hypopituitarism / drug therapy
  • Hypopituitarism / etiology
  • Lung Neoplasms / pathology
  • Middle Aged
  • Nivolumab / adverse effects*
  • Nivolumab / therapeutic use
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Antineoplastic Agents, Immunological
  • Nivolumab
  • Hydrocortisone