{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:23:52Z","timestamp":1791559432800,"version":"4.3.4"},"reference-count":11,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,2]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>A man in his 70s with lung adenocarcinoma (cStage IVA) received POSEIDON-based therapy with durvalumab, tremelimumab and chemotherapy. After six cycles, progressive disease prompted a switch to carboplatin plus nab-paclitaxel. Nineteen weeks after the final immune checkpoint inhibitor (ICI) administration, he developed fatigue and anorexia. Adrenocorticotropic hormone (ACTH) and cortisol were below assay detection limits, and a corticotropin-releasing hormone stimulation test showed no ACTH response, consistent with ICI-related isolated ACTH deficiency. Symptoms improved with hydrocortisone replacement. Five weeks later, he developed diabetic ketoacidosis, with a glucose level of 30.4\u2009mmol\/L (reference range, 3.9\u20136.1\u2009mmol\/L) and a ketone level of 6.3\u2009mmol\/L (&lt;0.6\u2009mmol\/L). HbA1c and urinary C-peptide excretion were 6.9% (4.6%\u20136.2%)\u2009and 1.8\u2009nmol\/day (7.5\u201351.4\u2009nmol\/day) respectively. These findings supported a diagnosis of fulminant type 1 diabetes mellitus, considered ICI-related. This case highlights the need for continued vigilance, as immune-related adverse events may develop sequentially even after ICI therapy has ended.<\/jats:p>","DOI":"10.1136\/bcr-2026-274439","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:40:13Z","timestamp":1786538413000},"page":"e274439","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Sequential development of isolated ACTH deficiency and fulminant type 1 diabetes as delayed immune-related endocrine adverse events"],"prefix":"10.1136","volume":"19","author":[{"given":"Mei","family":"Ishikawa","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satsuki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuyo","family":"Shintani","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026091107251476000_19.8.e274439.1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jtho.2024.09.1381","article-title":"Durvalumab With or Without Tremelimumab in Combination With Chemotherapy in First-Line Metastatic NSCLC: Five-Year Overall Survival Outcomes From the Phase 3 POSEIDON Trial","volume":"20","author":"Peters","year":"2025","journal-title":"J Thorac 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