Neurocognitive Function, Psychosocial Outcome, and Health-Related Quality of Life of the First-Generation Metastatic Melanoma Survivors Treated with Ipilimumab

Figure 2

Case illustration. Sagittal section of a gadolinium-enhanced magnetic resonance image from a patient who developed acute symptomatic immune-related hypophysitis leading to an isolated insufficiency of the corticotropic axis. The patient had an Addison crisis three weeks after the fourth administration of IPI (cumulative dose 1080 mg). The MRI image reveals a diffusely swollen and gadolinium-enhanced pituitary gland with a hypointense lesion in the right adenohypophysis and thickening of the stalk. Laboratory findings showed undetectable ACTH levels at the time of diagnosis. The patient was diagnosed with posttraumatic stress disorder (PTSD) related to the symptoms of an Addison crisis with comorbid depressive mood, fatigue, suicidal ideation, psychomotor retardation, and severe subjective neurocognitive symptoms. After one year of psychiatric follow-up, the patient recovered from depression and PTSD; however, he had a recurrence of depression two years later due to fear of recurrence, which again was successfully treated after psychiatric intervention.