[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-405511-105":59,"doc-detail-405511-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","immune-checkpoint-inhibitor-induced-diabetes-mellitus-with-nivolumab","Immune checkpoint inhibitor-induced diabetes mellitus with nivolumab","","Immune checkpoint inhibitor therapy is increasingly used for advanced cancers, but immune-related adverse events can complicate treatment. This case report describes a man in his 40s with metastatic melanoma treated with nivolumab who developed immune checkpoint inhibitor-induced diabetes mellitus without ketoacidosis. Hyperglycaemia was detected incidentally when he presented to the emergency department for an urticarial rash. Haemoglobin A1c and C-peptide testing supported the diagnosis and appropriate diabetes treatment was initiated. The report highlights an atypical presentation and the need for clinician awareness.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/immune-checkpoint-inhibitor-induced-diabetes-mellitus-with-nivolumab/405511/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/immune-checkpoint-inhibitor-induced-diabetes-mellitus-with-nivolumab/405511.png","ImageObject",300,407,{"name":92,"@type":93},"Emma Wilson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment led to the patient developing ICI-induced diabetes mellitus?","Question",{"text":112,"@type":113},"The patient was receiving nivolumab immunotherapy for metastatic melanoma, after initial combination therapy with nivolumab and ipilimumab.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the diabetes mellitus first identified in this case?",{"text":117,"@type":113},"Hyperglycaemia was incidentally noted when the patient presented to the emergency department for an urticarial rash, and further testing supported ICI-DM.",{"name":119,"@type":110,"acceptedAnswer":120},"Why was ketoacidosis considered absent at presentation?",{"text":121,"@type":113},"The report states that hyperglycaemia occurred in the absence of ketoacidosis, with investigations showing ketones and additional diagnostic testing consistent with ICI-DM.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},405511,1790880329,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Case report  \nImmune checkpoint inhibitor-induced diabetes mellitus with nivolumab  \nAnis Zand Irani, 1,2 Holly Gibbons,3 Wen Xing Teh4  \n1Endocrinology, Gympie Hospital, Gympie, Queensland, Australia  \n2Griffith University, Sunshine Coast, Queensland, Australia 3Charleville Hospital, Charleville, Queensland, Australia 4Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia  \nCorrespondence to  \nDr Wen Xing Teh;  \n[wenxing1807@gmail.com](wenxing1807@gmail.com)  \nAccepted 20 March 2023  \n© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.  \nTo cite: Zand Irani A, Gibbons H, Teh WX. BMJ Case Rep 2023;16:e253696 . doi:10 . 1136/bcr-2022- 253696  \nSUMMARY  \nImmune checkpoint inhibitors (ICIs) have been increasingly used in the treatment of various advanced cancers; however, therapy can be complicated by immune-related adverse events (irAEs) . We present the case of a man in his 40s, with metastatic melanoma treated with nivolumab immunotherapy who developed ICI-induced diabetes mellitus (ICI-DM) . Hyperglycaemiain the absence of ketoacidosis was incidentally noted when he presented to the emergency department for review of an urticarial rash. Further testing, including haemoglobin A1c and C-peptide level, confirmed his presentation was most consistent with ICI-DM and he was commenced on appropriate diabetes treatment. This report aims to detail an atypical presentation of ICI-DM and to highlight the importance of clinician awareness in identifying this irAE in patients receiving ICIs.  \nBACKGROUND  \nDevelopments in targeted immunotherapy have resulted in marked improvements in outcomes and survival in patients with various advanced cancers. The two main subclasses of immune checkpoint inhibitors (ICIs) are programmed death-1 receptor (PD-1) inhibitors including programmed deathligand 1 (PD-L1) inhibitors and second subclass cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors. ICIs reverse negative immune regulation and promote the immune response towards targeting cancer cells. However, they can also lead to immune-related adverse events (irAEs) in any organ system, with endocrinopathies being among those more commonly reported.1 ICIinduced diabetes mellitus (ICI-DM) is one such endocrinopathy and has particular clinical significance as the majority of patients present in diabetic ketoacidosis (DKA) and require lifelong treatment with insulin therapy.2 ICI-DM has been reported with PD-1 and PD-L1 inhibitors and rarely with CTLA-4 inhibitors.2 3  \nNivolumab, a PD-1 inhibitor, is approved for the treatment of metastatic melanoma, non-small cell lung cancer, mesothelioma, renal cell carcinoma and head, neck and oesophageal squamous cell carcinoma. This report details a case of ICI-DM identified due to hyperglycaemia without ketoacidosis in a patient receiving nivolumab immunotherapy for metastatic melanoma.  \nCASE PRESENTATION  \nA man in his 40s presented to the emergency department of a regional hospital with a 2-day history of generalised urticarial rash.  \nHe was diagnosed with a melanoma on his upper back a year prior and had metastases in the left axillary, subpectoral and bilateral cervical lymph nodes identified on PET scan at the time of diagnosis. The melanoma was BRAF positive and the primary was unresectable. He was referred to medical oncology and commenced on nivolumab/ipilimumab, a combination of PD-1 and CTLA-4 inhibitors. His baseline endocrine workup prior to initiation of treatment, which included morning cortisol, thyroid function tests (TFTs) and random blood glucose, was unremarkable.  \nHis initial combination therapy involved four doses of ipilimumab (3 mg/kg) with nivolumab (1 mg/kg), and he was subsequently continued on monthly nivolumab, receiving 13 doses prior to presentation. He experienced a localised erythematous rash 2 weeks after his first dose of immunotherapy, however had n","cbCaicwENWI3OgMb","https://ap.wps.com/l/cbCaicwENWI3OgMb","pdf",167513,"English","# Summary\n# Background\n# Nivolumab and treatment context\n# Case presentation\n## Clinical presentation and history\n## Examination\n# Investigations and diagnosis\n## Bedside findings\n## Laboratory results","[{\"question\":\"What treatment led to the patient developing ICI-induced diabetes mellitus?\",\"answer\":\"The patient was receiving nivolumab immunotherapy for metastatic melanoma, after initial combination therapy with nivolumab and ipilimumab.\"},{\"question\":\"How was the diabetes mellitus first identified in this case?\",\"answer\":\"Hyperglycaemia was incidentally noted when the patient presented to the emergency department for an urticarial rash, and further testing supported ICI-DM.\"},{\"question\":\"Why was ketoacidosis considered absent at presentation?\",\"answer\":\"The report states that hyperglycaemia occurred in the absence of ketoacidosis, with investigations showing ketones and additional diagnostic testing consistent with ICI-DM.\"}]","Immune checkpoint inhibitor-induced diabetes mellitus with nivolumab | PDF",1790560321]