Case Reports in Endocrinology

Case Report

A Case of Type 2 Diabetes Mellitus with Lung Cancer Suffered from Euglycemic Diabetic Ketosis Accompanied by Adrenal Insufficiency after Immune Checkpoint Inhibitors

Table 1

Patient laboratory data from the time of administration and the results of endocrine loading tests.


Complete blood count			Biochemical blood test
WBC	9640	/μL	AST	26	U/L
Neut	64.2	%	ALT	11	U/L
Lymp	18.6	%	LDH	168	U/L
Mono	6.7	%	γ-GTP	15	U/L
Eos	9.9	%	CPK	464	U/L
Baso	0.6	%	TP	6.0	g/dL
RBC	4.96 × 10⁶	/μL	ALB	2.8	g/dL
Hb	14.3	g/dL	BUN	26.3	mg/dL
Ht	44.2	%	Cr	1.07	mg/dL
PLT	463 × 10³	/μL	Na	132	mEq/L
Urinary test			K	5.1	mEq/L
Specific gravity	1.030		Cl	97	mEq/L
pH	6.0		Modified Ca	11.6	mg/dL
Sugar	(4+)		P	3.8	mg/dL
Blood	(−)		CRP	16.6	mg/dL
Protein	(−)		NH3	21	μg/dL
Ketone body	(3+)		T-Bil	0.52	mg/dL
WBC	(−)		AMY	32	U/L
Bacteria	(−)		Vit B12	57.2	ng/mL
Venous blood gas			Cortisol	7.1	μg/dL
pH	7.40		CYFRA	3.0	ng/mL
PCO2	28.7	torr	eGFR	53	ml/min/L
PO2	77.0	torr	Diabetes/thyroid blood test
HCO3	17.4	mmol/L	Glucose	121	mg/dL
SBE	−6.5	mmol/L	HbA1c	9.3	%
Lac	7.0	mg/dL	C-peptide	1.47	ng/mL
Venous ketone body			freeT4	1.21	ng/dL
Total ketone body	7071	μmol/L	TSH	2.850	μIU/mL
Acetoacetic acid	2076	μmol/L	GADA	<5.0	U/mL
3-hydroxybutyric acid	4995	μmol/L	Tg-Ab	24.9	U/mL
			TPO-Ab	3.0	U/mL
Endocrine loading tests
Rapid-ACTH test
	0 min	30 min	60 min		Unit
ACTH	<1.5				pg/mL
Cortisol	0.2	5.0	6.6		μg/dL
CRH, TRH and GnRH loading tests
	0 min	30 min	60 min	90 min	Unit
ATCH	<1.5	4.7	2.0		pg/mL
Cortisol	0.5		1.2	0.9	μg/dL
PRL	33.3	93.1	86.7		ng/mL
TSH	2.34	9.54	9.01		μIU/mL
LH	6.6	33.0	38.0		mIU/mL
FSH	15.6		24.6	27.3	mIU/mL
GHRP2 loading test
	0 min	15 min	30 min	45 min	60 min
GH	0.88	82.6	96.4	78.7	43.9
IGF-1	122	(Units of GH, IGF-1; ng/mL)

CYFRA, cytokeratin 19 fragment; GADA, anti-glutamic acid decarboxylase antibody; Tg-Ab, anti-thyroglobulin antibody; TPO-Ab, anti-thyroid peroxidase antibody; ACTH, adrenocorticotropic hormone; PRL, prolactin; TSH, thyroid stimulating hormone; LH, luteinizing hormone; FSH, follicle stimulating hormone; GH, growth hormone; IGF-1, insulin-like growth factor-1; CRH, corticotropin-releasing hormone; TRH, thyrotropin releasing hormone; GnRH, gonadotropin releasing hormone; GHRP2 growth hormone releasing peptide 2.