SHM Converge Scientific Abstract ePoster Gallery-Gad-65 Positive Immune Mediated Diabetic Ketoacidosis

Pdf Summary

This case report describes a 72-year-old man with stage III metastatic melanoma who developed immune-mediated diabetic ketoacidosis (DKA) after treatment with the checkpoint inhibitors ipilimumab and nivolumab. His history was notable only for hypertension. He had previously undergone two surgical resections of a melanoma on his back, then later developed axillary nodal recurrence and began combination immunotherapy. After three cycles, he presented to the emergency department with one week of fatigue, lethargy, poor appetite, nausea, vomiting, hypotension, and tachypnea.<br /><br />Laboratory testing showed severe hyperglycemia with an elevated anion gap metabolic acidosis, consistent with DKA. He was treated with standard DKA management, including IV fluids and an insulin drip, and remained on the drip until the anion gap closed over four days. Endocrinology evaluation and immune-mediated diabetes testing were performed. Anti-GAD antibodies were elevated, supporting an autoimmune, checkpoint inhibitor–related cause of diabetes. He was discharged after seven days on basal-bolus insulin therapy and high-dose sliding scale insulin, with improved glucose control in the 140–170 mg/dL range. His axillary node disease also became unpalpable after treatment.<br /><br />The discussion emphasizes that immune checkpoint inhibitors can cause multiple endocrine toxicities, including thyroid dysfunction, hypophysitis, adrenal insufficiency, and insulin-dependent diabetes. Autoimmune diabetes from these agents is rare but serious, occurring in about 1% of patients. DKA may be the first presentation, and clinicians should evaluate any new significant hyperglycemia in patients receiving checkpoint inhibitors. Management includes hospital treatment for DKA, endocrine consultation, testing for autoimmune markers such as anti-GAD antibodies, and holding immunotherapy until glucose control is stable.

Asset Subtitle

Dinesh Keerty

Meta Tag

Author List Dinesh Keerty, Hardik Thakkar, Julie E. Hallanger-Johnson, Nikhil Khushalani

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor Therapy

Concept Diabetes Mellitus

Concept Diabetic Ketoacidosis

Concept Endocrine Toxicity

Concept Insulin Infusion

Distinguished Non-Finalist

Presenter Organization Moffitt Cancer Center

Presenting Author Dinesh Keerty

Track Adult

Keywords

metastatic melanoma

immune-mediated diabetic ketoacidosis

checkpoint inhibitors

ipilimumab

nivolumab

anti-GAD antibodies

autoimmune diabetes

endocrine toxicity

anion gap metabolic acidosis

basal-bolus insulin

Immune Checkpoint Inhibitor Therapy

Diabetes Mellitus

Diabetic Ketoacidosis

Endocrine Toxicity

Insulin Infusion