{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:36:41Z","timestamp":1761863801737,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,12,27]]},"abstract":"<jats:p>The authors describe a case of a life-threatening diabetic emergency 25 days after initiation of nivolumab (3\u2009mg\/kg) for stage 4 lung adenocarcinoma. She was admitted to the emergency department, with hyperglycaemia-related signs and symptoms, such as polyuria, polydipsia, weight loss, confusion, asthenia, dehydration, hypotension and Kussmaul respiratory pattern. Her body mass index was 21.9\u2009kg\/m<jats:sup>2<\/jats:sup> and she did not show acanthosis nigricans. Arterial blood gas determination revealed high anion gap metabolic acidaemia and blood tests showed hyperglycaemia (1060\u2009mg\/dL), hyperketonaemia (beta-hydroxybutyrate: 6.6\u2009mmol\/dL), elevated total serum osmolality (389 mOsm\/kg), low serum and urinary C-peptide and positive antiglutamic acid decarboxylase antibodies. Since nivolumab was initiated a few days before, and due to its known immune-mediated endocrine adverse events, we assumed the diagnosis of new onset immune-mediated type 1 diabetes mellitus. After prompt and adequate treatment of diabetic ketoacidosis\/hyperosmolar hyperglycaemic state, she was discharged improved on multiple daily injections of insulin.<\/jats:p>","DOI":"10.1136\/bcr-2017-220999","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T10:48:16Z","timestamp":1517568496000},"page":"bcr-2017-220999","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["New onset diabetes after nivolumab treatment"],"prefix":"10.1136","volume":"2018","author":[{"given":"Ricardo","family":"Capitao","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,1,29]]},"reference":[{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-014-0234-4"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.2","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/jdi.12531","article-title":"Fulminant type\u00a01 diabetes mellitus with anti-programmed cell death-1 therapy","volume":"7","author":"Okamoto","year":"2016","journal-title":"J Diabetes Investig"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2337\/dc14-2349","article-title":"Precipitation of autoimmune diabetes with anti-PD-1 immunotherapy","volume":"38","author":"Hughes","year":"2015","journal-title":"Diabetes Care"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.4","unstructured":"U.S. Food and Drug Administration. Last updated November 2015, Revised May 2016. Nivolumab FDA Label. available at https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/125554s019lbl.pdf. Reference ID: 3932569."},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.5","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-9032"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.6","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s40425-016-0196-z","article-title":"Genetic risk analysis of a patient with fulminant autoimmune type 1 diabetes mellitus secondary to combination ipilimumab and nivolumab immunotherapy","volume":"4","author":"Lowe","year":"2016","journal-title":"J Immunother Cancer"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.7","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s00262-017-2033-8","article-title":"Autoimmune diabetes induced by PD-1 inhibitor-retrospective analysis and pathogenesis: a case report and literature review","volume":"66","author":"Gauci","year":"2017","journal-title":"Cancer Immunol Immunother"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s12185-016-2101-4","article-title":"Fulminant type I diabetes mellitus associated with nivolumab in a patient with relapsed classical Hodgkin lymphoma","volume":"105","author":"Munakata","year":"2017","journal-title":"Int J Hematol"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.9","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/1346-8138.13486","article-title":"Case of type 1 diabetes associated with less-dose nivolumab therapy in a melanoma patient","volume":"44","author":"Teramoto","year":"2017","journal-title":"J Dermatol"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1620\/tjem.239.155","article-title":"Nivolumab, an anti-programmed cell death-1 antibody, induces fulminant type 1 diabetes","volume":"239","author":"Miyoshi","year":"2016","journal-title":"Tohoku J Exp Med"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.11","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ejca.2016.02.025","article-title":"Cutaneous, gastrointestinal, hepatic, endocrine, and renal side-effects of anti-PD-1 therapy","volume":"60","author":"Hofmann","year":"2016","journal-title":"Eur J Cancer"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.12","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.jtho.2016.12.015","article-title":"Association of serum Anti-GAD antibody and HLA haplotypes with type 1 diabetes mellitus triggered by\u00a0nivolumab in patients with non-small cell lung\u00a0cancer","volume":"12","author":"Usui","year":"2017","journal-title":"J Thorac Oncol"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.13","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1684\/ejd.2016.2923","article-title":"A case of fulminant type 1 diabetes mellitus, with a precipitous decrease in pancreatic volume, induced by nivolumab for malignant melanoma: analysis of HLA and CTLA-4 polymorphisms","volume":"27","author":"Ishikawa","year":"2017","journal-title":"Eur J Dermatol"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/jppr.1247","article-title":"Nivolumab-induced autoimmune diabetes","volume":"47","author":"Chan","year":"2017","journal-title":"J Pharm Pract Res"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.15","doi-asserted-by":"crossref","first-page":"255A","DOI":"10.1016\/j.chest.2016.08.268","article-title":"Nivolumab-induced autoimmune diabetic ketoacidosis","volume":"150","author":"Zaied","year":"2016","journal-title":"Chest"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.16","doi-asserted-by":"crossref","unstructured":"Matsumura K , Nagasawa K , Oshima Y , et al . Aggravation of diabetes, and incompletely deficient insulin secretion in a case with type 1 diabetes-resistant human leukocyte antigen DRB1*15:02 treated with nivolumab. J Diabetes Investig 2017.doi:10.1111\/jdi.12679","DOI":"10.1111\/jdi.12679"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.17","doi-asserted-by":"crossref","unstructured":"Godwin JL , Jaggi S , Sirisena I , et al . Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer. J Immunother Cancer 2017;5.doi:10.1186\/s40425-017-0245-2","DOI":"10.1186\/s40425-017-0245-2"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.18","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00262-016-1835-4","article-title":"A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome","volume":"65","author":"Hansen","year":"2016","journal-title":"Cancer Immunol Immunother"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.19","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00262-016-1913-7","article-title":"A case of pembrolizumab-induced type-1 diabetes mellitus and discussion of immune checkpoint inhibitor-induced type 1 diabetes","volume":"66","author":"Chae","year":"2017","journal-title":"Cancer Immunol Immunother"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.20","doi-asserted-by":"publisher","DOI":"10.1007\/s00262-015-1689-1"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.21","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0889"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.22","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1331"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.23","doi-asserted-by":"crossref","unstructured":"Aleksova J , Lau PK , Soldatos G , et al . Glucocorticoids did not reverse type 1 diabetes mellitus secondary to pembrolizumab in a patient with metastatic melanoma. BMJ Case Rep 2016;2016:.doi:10.1136\/bcr-2016-217454","DOI":"10.1136\/bcr-2016-217454"},{"key":"2025082802161068000_2018.jan27_1.bcr-2017-220999.24","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12603"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-220999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:16:23Z","timestamp":1756372583000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-220999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,29]]},"references-count":24,"alternative-id":["10.1136\/bcr-2017-220999"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-220999","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,1,29]]}}}