Long-term imaging characteristics of the pancreas related to diabetes induced by immune checkpoint inhibitor therapy.
Seiji Tomofuji, Shin Urai, Kei Yoshino et al.
✦ AI-curated · Sources linked
Case in brief
A patient developed sudden hyperglycemia during pembrolizumab treatment for renal cell carcinoma, necessitating insulin therapy. Serum C-peptide levels dropped below detection, while pancreatic enzyme levels remained normal. Initial MRI showed diffuse high signal intensity on diffusion-weighted imaging and reduced apparent diffusion coefficient values across the pancreas. Over 25 months, serial imaging revealed ongoing pancreatic atrophy, with persistent DWI/ADC findings.
What made this case unusual
The case highlights the unique long-term MRI characteristics of the pancreas in the context of immune checkpoint inhibitor-induced diabetes, particularly the persistence of diffusion-related imaging findings despite progressive atrophy.
Diagnostic / clinical pearl
Clinicians should be aware that immune checkpoint inhibitor-induced diabetes can lead to significant pancreatic changes observable on MRI, including persistent diffusion-weighted imaging abnormalities.
Why it matters
Understanding the imaging characteristics associated with ICI-induced diabetes can aid in the diagnosis and management of this rare adverse event, emphasizing the need for careful monitoring of pancreatic health in affected patients.