Coexistence of Immune Checkpoint Inhibitor-Induced Autoimmune Diabetes and Pancreatitis

被引:15
作者
Zhang, Amy L. [1 ]
Wang, Fang [1 ]
Chang, Lee-Shing [1 ]
McDonnell, Marie E. [1 ]
Min, Le [1 ]
机构
[1] Brigham & Womens Hosp, Div Endocrinol Diabet & Hypertens, 75 Francis St, Boston, MA 02115 USA
来源
FRONTIERS IN ENDOCRINOLOGY | 2021年 / 12卷
关键词
autoimmune diabetes; immunotherapy; pancreatitis; endocrine toxicity; immune check inhibitor (ICI); MELLITUS; PATIENT;
D O I
10.3389/fendo.2021.620522
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Autoimmune diabetes is a rare but severe endocrine toxicity induced by immune checkpoint inhibitor (ICI) treatment. It is unclear if ICI causes selective islet toxicity or non-selective pancreas toxicity. We analyzed 11 patients treated with ICI who developed ICI-related autoimmune diabetes. Eight patients had lipase and/or amylase tested on the same day of diagnosis of autoimmune diabetes. Among them, 75% (6/8) had normal lipase and 100% (6/6) had normal amylase. There was no correlation between glucose level at onset and biochemical pancreatitis. We characterized the clinical features of ICI-induced autoimmune diabetes. Fifty-five percent (6/11) of patients tested positive for GAD65 autoantibodies, and 55% (6/11) developed diabetic ketoacidosis at manifestation of hyperglycemia. In all 11 patients, C-peptide levels were low in the presence of hyperglycemia. ICI-induced thyroiditis was found in 64% (7/11), of which 36% (4/11) were newly diagnosed with thyroiditis while the remaining 27% (3/11) had pre-existing hypothyroidism followed by ICI-induced thyroiditis. Additionally, 27% (3/11), developed ICI-induced hypophysitis. Thyroiditis and autoimmune diabetes coexisted in all patients with ICI-induced hypophysitis. The median time from ICI treatment to the onset of autoimmune diabetes was 11 weeks. Our data suggest that few patients had coexistent ICI-induced autoimmune diabetes and pancreatitis, suggesting ICI mainly caused selective islet toxicity.
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页数:5
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