Immune checkpoint inhibitor-induced hypophysitis with transient ACTH-dependent hypercortisolism.

A woman in her 70s with metastatic melanoma presenting with refractory hypokalaemia on combined immune checkpoint inhibitors, nivolumab-ipilimumab, was diagnosed with adrenocorticotropic hormone (ACTH)-dependent hypercortisolism 11 weeks following the initiation of her immunotherapy. Investigations also demonstrated central hypothyroidism and hypogonadotropic hypogonadism. She underwent imaging studies of her abdomen and brain which revealed normal adrenal glands and pituitary, respectively. She was started on levothyroxine replacement and had close pituitary function monitoring. Two weeks later, her cortisol and ACTH levels started to trend down. She finally developed secondary adrenal insufficiency and was started on hydrocortisone replacement 4 weeks thereafter.This report highlights a case of immunotherapy-related hypophysitis with well-documented transient central hypercortisolism followed, within weeks, by profound secondary adrenal insufficiency. Healthcare professionals should remain vigilant in monitoring laboratory progression in these patients. Early recognition of the phase of hypercortisolism and its likely rapid transformation into secondary adrenal insufficiency can facilitate timely hormonal replacement and prevent complications.

Fitness of the Papaya Mealybug, Paracoccus marginatus (Hemiptera: Pseudococcidae), after Transferring from Solanum tuberosum to Carica papaya, Ipomoea batatas, and Alternanthera philoxeroides.

The papaya mealybug, Paracoccus marginatus Williams and Granara de Willink (Hemiptera: Pseudococcidae), is a polyphagous invasive pest in China. The effect that the shifting of the host plant has on the fitness of a polyphagous pest is critical to its prevalence and potential pest control. In order to assess the fitness changes of P. marginatus after transferal from potato (Solanum tuberosum (Tubiflorae: Solanaceae)) to papaya (Carica papaya (Parietales: Caricacea)), sweet potato (Ipomoea batatas (Tubiflorae: Convolvulaceae)), and alligator weed (Alternanthera philoxeroides (Centrospermae: Amaranthaceae)), the life table data of three consecutive generations were collected and analyzed using the age-stage, two-sex life table method. The results showed that when P. marginatus was transferred from S. tuberosum to papaya, a higher intrinsic rate of increase (r) and finite rate of increase (λ) were observed. Paracoccus marginatus individuals transferred to I. batatas had the significantly lower population parameters than those on C. papaya; however, the fitness recovered for those on I. batatas after two generations. Paracoccus marginatus individuals were unable to complete development on A. philoxeroides. Our results conclusively demonstrate that P. marginatus individuals can readily adapt to C. papaya and I. batatas even after host plant shifting, and are capable of causing severe damage to these hosts.