PMC6356048_01
a. Chest roentgenogram. X-ray findings at admission included a tumor mass shadow in the upper lung field, left costophrenic (CP) angle blunting, and a central venous access port device planted in the left subclavian vein. b. Plain chest-abdominal computed tomography (CT). CT findings included a 50-mm tumor mass shadow in the left superior lobe, left pleural effusion, and absence of gut distention or niveau formation.
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Chest roentgenogram findings at admission (Fig. 1a) included a tumor mass shadow in the upper lung field, left costophrenic (CP) angle blunting, and a central venous access port device planted in the left subclavian vein. Plain chest-abdominal CT findings (Fig. 1b) included a 50-mm tumor mass shadow in the left superior lobe, left pleural effusion, and absence of gut distention or niveau formation.
Pituitary MRI. MRI findings revealed no pituitary enlargement.
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ACTH/cortisol response, while the thyrotropin-releasing hormone (TRH) test and luteinizing hormone-releasing hormone (LHRH) test elicited an intact TRH/LHRH response, in this patient, which led to the diagnosis of isolated ACTH deficiency, with the pituitary determined as the responsible organ. Again, based on the pituitary MRI (Fig. 2) finding suggestive of no pituitary enlargement and the fact that this ACTH deficiency developed during nivolumab therapy, the condition was finally diagnosed as nivolumab-induced isolated ACTH deficiency.