PMC9807149_01
Time course of the total daily dose (TDD) of insulin and hemoglobin A1c (HbA1c) levels. The patient received seven cycles of pembrolizumab therapy for lung cancer. A total of 16 days after the last dose, he was diagnosed with immune checkpoint inhibitor (ICI)-associated secondary adrenal insufficiency. A daily maintenance dose of 15 mg hydrocortisone was initiated. A total of 13 days after diagnosis (X), he was urgently admitted for severe liver dysfunction and hyperglycemia with ketosis. He was subsequently diagnosed with ICI-associated diabetes mellitus (ICI-DM) and insulin therapy was initiated. He had an initial TDD of 24 units of insulin that was gradually reduced over time. Six months later, the recovery of insulin secretion was confirmed using a glucagon challenge test, and insulin therapy was discontinued. Although his HbA1c levels were 6.1-6.2% during the pembrolizumab administration, they increased to 8.1% at the onset of ICI-DM. After discontinuing insulin therapy, his HbA1c levels reduced to 5.9-6.0% without medication.
JDI-14-147-g001.jpg
PMC9807149_01_JDI-14-147-g001.jpg
jdi13927-fig-0001
A total of 16 days after the last dose, he complained of fatigue and was diagnosed with ICI-associated secondary adrenal insufficiency (Figure 1).