2021 Volume 64 Issue 10 Pages 529-535
A 75-year-old man with metastatic melanoma was administered pembrolizumab beginning in March 20xx. He developed appetite loss and other symptoms in August after eight courses of pembrolizumab therapy and presented to our department in September. He was diagnosed with adrenocortical insufficiency based on findings of hyponatremia, eosinophilia, and hypocortisolemia and received hydrocortisone (15 mg). Laboratory investigations revealed a blood glucose level of 203 mg/dL, glycosylated hemoglobin of 7.3 %, and urinary ketones 2+. His blood glucose level increased to 529 mg/dL, and urinary ketones were 2+at 1 week later. Following a thorough evaluation, he was diagnosed with fulminant type 1 diabetes and concomitant secondary adrenocortical insufficiency, attributable to immune-related adverse events secondary to anti-programmed cell death-1 antibody therapy. Fulminant type 1 diabetes with concomitant secondary adrenocortical insufficiency as observed in this case is extremely rare. These diseases produce opposite effects on blood glucose levels, and both are associated with moderately elevated blood glucose levels. We herein report a rare case of the aforementioned conditions that were difficult to diagnose at the first visit. Our findings may serve as guidelines for clinicians, and this report will be of substantial interest to the medical community owing to its educational value.
