Autoimmune Polyendocrinopathy Induced by an Antibody (KN046) That Simultaneously Inhibits PD-L1 and CTLA-4: A Case Report and Literature Review

Figures & data

Table 1 Laboratory Results for the Patient

Variable	Value	Reference Range
Biochemistry
ALT (U/L)	17	9–60
AST (U/L)	33	17–59
K (mmol/L)	4.36	4.36
Na (mmol/L)	137	13–148
Cl (mmol/L)	107	96–108
Uric acid (umol/L)	611	208–428
Creatinine (umol/L)	124	57–97
HCO3- (mmol/L)	8.0	22–29
Plasma osmolality (mOSM/L)	286.4	275–320
Diabetes-related examination
Glucose (mg/dl)	317.3	70–109
HbA1c (%)	9.2	4.6~6.0
ICA	-	-
GAD-Ab (u/mL)	0.14	<0.9
IAA	-	-
Endocrinological examination
TT3 (nmol/L)	0.42	1.01~2.95
TT4 (nmol/L)	27.80	55.34~160.88
FT3 (pmol/L)	2.83	2.77–6.5
FT4 (pmol/L)	10.53	10.43–24.32
TSH (mIU/mL)	2.85	0.4~4.34
TPOAb (U/mL)	163.10	<60
TgAb (U/mL)	>500	<60
TRAb (U/L)	<0.1	<1
8am ACTH (pg/mL)	23.30	5~50
4pm ACTH (pg/mL)	<5	69~345
8am cortisol (nmol/L)	32.30	138~690
4pm cortisol (nmol/L)	<27.50	69~345
FSH (mIU/mL)	19.20	0.8–5.1
LH (mIU/mL)	3.76	0.8–6.3
GH (ng/mL)	3.78	<5
PRL (ng/mL)	3.75	2–18
Testosterone (ng/dl)	291	260–1320
IGF-1 (ng/mL)	46.7	94–252
Blood amylase (U/L)	23	30~135
Blood lipase (U/L)	145	23~300
Steamed bread meal experiment
FBG (mg/dl)	135	79.2-109.8
GLU 0.5h (mg/dl)	203.76	140.04-160.02
GLU 1h (mg/dl)	342.36	120.6-149.4
GLU 2h (mg/dl)	429.30	90-129.6
Insulin (mIU/L)	12.70	4–20
Insulin 0.5h (mIU/L)	9.50	20.5–108.9
Insulin 1h (mIU/L)	8.20	20.5–108.9
Insulin 2h (mIU/L)	8.65	11–91.6
C-peptide (ng/mL)	<0.1	0.65–2.45
C-peptide 0.5h (ng/mL)	<0.1	3.16–2.45
C-peptide 1h (ng/mL)	<0.1	3.16–8.45
C-peptide 2h (ng/mL)	<0.1	2.74–7.38
Urinalysis
Urine glucose	+	-
Urine ketone	+++	-
Urine protein	+++	-

Abbreviations: ALT, alanine transaminase; AST, aspartate aminotransferase; HbA1c, hemoglobin A1c; ICA, islet cell antibody; GAD-Ab, glutamic acid decarboxylase antibody; IAA, insulin autoantibody; TT3, triiodothyronine; TT4, thyroxin; FT3, free triiodothyronine; FT4, free thyroxine; TSH, thyroid-stimulating hormone; TPOAb, thyroid peroxidase antibody; TgAb, antithyroglobulin antibody; ACTH, adrenocorticotropic hormone; FSH, follicle stimulating hormone; LH, luteinizing hormone; GH, growth hormone; PRL, prolactin; IGF-1, insulin-like growth factor 1; FBG, fasting blood glucose.

Figure 1 Sagittal and coronal slices of the pituitary MRI (A) Precontrast T1-weighted coronal slices MRI image. (B) Postcontrast T1-weighted coronal slices MR image. (C) Precontrast T1-weighted sagitta slices MRI image. (D) Postcontrast T1-weighted sagitta slices MR image. (E) Precontrast T2-weighted coronal slices MRI image. (F) Postcontrast T2-weighted sagitta slices MR image.