Dataset Information

PD-1 inhibitor-associated type 1 diabetes: A case report and systematic review.

ABSTRACT:

Objective

This study aimed to summarize the clinical characteristics of programmed death receptor 1 (PD-1) inhibitor-associated type 1 diabetes so as to improve the ability of clinicians to correctly diagnose and treat it.

Methods

We reported a case of a 70-year-old woman with gastric cancer who developed hyperosmolar hyperglycemic coma during camrelizumab (a PD-1 inhibitor) treatment and was diagnosed with PD-1 inhibitor-associated type 1 diabetes. We conducted a systematic review of 74 case reports of type 1 diabetes associated with PD-1 inhibitor therapy published before June 2022.

Results

The patient developed type 1 diabetes with hyperosmolar hyperglycemic coma after receiving camrelizumab chemotherapy for 6 months (9 cycles). We searched 69 English articles comprising 75 patients, all of whom had been treated with a PD-1 inhibitor (nivolumab or pembrolizumab) and progressed to diabetes after an average of 6.11 (1-28) cycles. Nivolumab combined with ipilimumab (a cytotoxic T lymphocyte-associated protein 4 inhibitor) had the shortest onset (4.47 cycles on average). A total of 76% (57/75) of patients developed diabetic ketoacidosis (DKA) at onset, and 50.67% (38/75) of patients had C-peptide <0.1 ng/mL. Most of the patients were tested for insulin autoantibodies, with a positive rate of 33.33% (23/69); of these, 86.96% (20/23) were tested for glutamate decarboxylase antibody and 46.67% (35/75) were tested for human leukocyte antigen (HLA). HLA-DR4 was the most common type.

Conclusions

The progression of type 1 diabetes induced by PD-1 inhibitors is relatively rapid. Islet failure often occurs when detected, seriously endangering patients' lives. Patients treated with PD-1 inhibitors should closely monitor their plasma glucose level during treatment to detect, diagnose, and treat diabetes on time.

SUBMITTER: Lin C

PROVIDER: S-EPMC9389003 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

PD-1 inhibitor-associated type 1 diabetes: A case report and systematic review.

Lin Cuiping C Li Xuan X Qiu Yu Y Chen Zheng Z Liu Jianping J

Frontiers in public health 20220805

<h4>Objective</h4>This study aimed to summarize the clinical characteristics of programmed death receptor 1 (PD-1) inhibitor-associated type 1 diabetes so as to improve the ability of clinicians to correctly diagnose and treat it.<h4>Methods</h4>We reported a case of a 70-year-old woman with gastric cancer who developed hyperosmolar hyperglycemic coma during camrelizumab (a PD-1 inhibitor) treatment and was diagnosed with PD-1 inhibitor-associated type 1 diabetes. We conducted a systematic revie ...[more]

PMID: 35991054

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Project description:The treatment of asymptomatic hydronephrosis due to ureteropelvic junction obstruction (UPJO), as well as the timing and indications for surgical intervention, remain controversial. Diabetes insipidus (DI) is a rare disease in infants that is known to cause non-obstructive hydronephrosis, while its association with obstructive hydronephrosis has not been reported. Some studies have found that increased water intake is a predisposing risk factor of developing hydronephrosis. However, there are no studies or guidelines that indicate the specific follow-up intervals and surgical indications for mild hydronephrosis if predisposing risk factors persist. A 46-month-old boy was admitted to our Urology Department with a history of Society of Fetal Urology (SFU) Grade 2 prenatal left hydronephrosis, which was stable at SFU Grade 1-2 at regular postnatal follow-ups. The patient developed polydipsia and polyuria three months prior to admission, then he was considered as primary polydipsia by endocrinology and was treated with fluid restriction while the examination was negative. Renal ultrasound at follow-up demonstrated severe left hydronephrosis with an anterior-posterior diameter (APD) of 6.25 cm three months after symptom onset. Diuretic renography (DR) revealed a renal function of 13.7% with a glomerular filtration rate (GFR) of 11.25 mL/min. The patient was otherwise asymptomatic without any abdominal pain or vomiting. He underwent left pyelostomy immediately as well as laparoscopic left dismembered ureteropelvioplasty after three months, and a diagnosis of UPJO was confirmed. The patient had an uncomplicated postoperative recovery and the result of follow-up renal ultrasound was stable. However, the symptoms of polydipsia and polyuria did not improve significantly. He underwent pituitary magnetic resonance imaging (MRI) and pathological examination, the results of which were consistent with central DI caused by Langerhans cell hyperplasia four months postoperatively. This case indicates the need to pay attention to children with mild hydronephrosis undergoing regular observation and conservative treatment, as a sudden aggravation of the hydronephrosis and a rapid decline of renal function may occur if DI persists.

Dataset Information

PD-1 inhibitor-associated type 1 diabetes: A case report and systematic review.

Objective

Methods

Results

Conclusions

Publications

PD-1 inhibitor-associated type 1 diabetes: A case report and systematic review.

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