Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 10, Number 4, April 2018, pages 358-362

Isolated Adrenocorticotropic Hormone Deficiency and Severe Hypercalcemia After Destructive Thyroiditis in a Patient on Nivolumab Therapy With a Malignant Melanoma

Figure

Figure 1.
Figure 1. Bone scintigraphy on the day when the patient developed a disturbance of consciousness (mid December 2016). Front (left) and back (right) views are shown. An arrow shows the portion of left rib with a possible malignant melanoma metastasis.

Tables

Table 1. Hematological and Blood Chemistry Tests (Mid December 2016)
 
WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; Plt: platelet; TP: total protein; Alb: albumin; AST: aspartate transaminase; ALT: alanine transaminase; ALP: alkaline phosphatase; LDH: lactate dehydrogenase; GGT: gamma-glutamyl transpeptidase; T-Bil: total bilirubin; BUN: urea nitrogen; Cr: creatinine; Na: sodium; K: potassium; Cl: chlorine; P: phosphoric; Ca: calcium; FPG: fasting plasma glucose; HbA1c: hemoglobin A1c; FT4: free T4; FT3: free T3; TSH: thyroid-stimulating hormone; CRP: C-reactive protein.
Hematological
  WBC7,800/µL
  RBC416 × 104/µL
  Hb12.2 g/dL
  Ht37.3%
  Plt18.0 × 104/µL
Urinalysis
  Blood(-)
  Protein(-)
  Glucose(3+)
Blood chemistry
  TP6.8 g/dL
  Alb3.84 g/dL
  AST144 U/L
  ALT43 U/L
  ALP102 U/L
  LDH198 U/L
  GGT19 U/L
  T-Bil1.65 mg/dL
  BUN44 mg/dL
  Cr2.11 mg/dL
  Na136 mEq/L
  K5.3 mEq/L
  Cl97 mEq/L
  P4.6 mg/dL
  Ca14.2 mg/dL (corrected by albumin 14.36)
  FPG139 mg/dL
  HbA1c5.7%
  FT41.00 ng/dL
  FT32.76 pg/mL
  TSH15.73 µU/mL
  CRP20.73 mg/dL

 

Table 2. CRH, TRH and LHRH Loading Tests
 
CRH: corticotropin-releasing hormone; TRH: thyrotropin-releasing hormone; LHRH: luteinizing hormone-releasing hormone; ACTH: adrenocorticotropic hormone; TSH: thyroid-stimulating hormone; LH: luteinizing hormone; PRL: prolactin; FSH: follicle-stimulating hormone. CRH 100 µg, TRH 0.5 mg, LHRH 0.1 mg with 10 mL normal saline was injected intravenously under rest spine state.
ACTH
  0 min< 2.0 pg/mL
  30 min< 2.0 pg/mL
  60 min< 2.0 pg/mL
Cortisol
  0 min0.34 µg/dL
  60 min0.35 µg/dL
  90 min0.36 µg/dL
LH
  0 min13.7 mIU/mL
  30 min41.2 mIU/mL
  60 min38.7 mIU/mL
FSH
  0 min9.8 mIU/mL
  60 min13.6 mIU/mL
  90 min13.0 mIU/mL
TSH
  0 min26.630 µU/mL
  30 min95.210 µU/mL
  60 min77.660 µU/mL
PRL
  0 min3.9 ng/mL
  30 min26.8 ng/mL
  60 min15.6 ng/mL