We describe a 58-year-old man with a malignant melanoma metastasis to the liver. After initiation of nivolumab therapy, he developed destructive thyroiditis and subsequently simultaneous isolated adrenocorticotropic hormone (ACTH) deficiency and severe hypercalcemia. Although isolated ACTH deficiency and hypercalcemia due to nivolumab therapy are both rare occurrences, these conditions can often cause a severe clinical course accompanied by a disturbance of consciousness. Therefore, clinicians should pay attention to these possible side effects of nivolumab if the patients have clinical symptoms, such as fatigue and a disturbance of consciousness.

Objective:The purpose of this study was to assess the association between blood pressure (BP) related indicators and physical frailty among the Japanese community-dwelling elderly.Design and method:The present cross-sectional analysis was based on an ongoing community-based intervention study in Nose, Osaka, which was designed to assess the effect of home BP measurement on prolonging healthy life expectancy. A total of 1153 participants, 420 were aged 63–91 and measured their home BP. Among them, 273 participants were currently available for analysis. Physical frailty was defined as a case either the weak grip strength defined as < 28 kg for males and < 18 kg for females or the slow gait speed defined as < 1 m/s. Participants measured their home BP and pulse rate (PR) with an oscillometric device (HEM-7281; Omron Healthcare CO., Ltd) and wrote the value on the recording book. The value of and variability in home BP and PR were calculated as the average and coefficient of variation (CV) of the measurements, respectively. Office BP was measured at the survey venue using same device, HEM-7281. The associations of BP related indicators with physical frailty were examined using multiple logistic regression models by age group: 63–74, and ≧ 75 years.Results:Overall, 195 participants were aged 63–74 years and 78 were aged ≧ 75 years. The percentage of physical frailty in each age group was 10.3% and 30.8%, respectively. Among participants aged 63–74 years, office systolic BP (odds ratio [OR] 0.964, 95% confidence interval [CI] 0.932–0.998) and female (OR 5.943, 95% CI 1.524–23.185) were associated with physical frailty. Among participants aged ≧ 75 years, CV of morning PR (OR 1.320, 95% CI 1.003–1.739) and age (OR 1.313, 95% CI 1.085–1.588), but not the BP level, were associated with physical frailty.Conclusions:The indicators associated to physical frailty differed depending on the age group. Among the relatively young old group, physical frailty was few with increasing office systolic BP. Among the older group aged ≧ 75 years, variability of PR was associated with physical frailty. There may be the influence of declined autonomic nervous function by aging or reduced muscle mass.

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome, and NICTH associated with gastrointestinal stromal tumor (GIST) is even more rare. Herein, we describe a patient with severe NICTH due to GIST who had developed liver cirrhosis as a consequence of chronic hepatitis B. Although circulating insulin, Cpeptide, and insulin-like growth factor-1 (IGF-1) levels were significantly decreased, in contrast to our expectations, the growth hormone (GH) level was slightly elevated. Steroid therapy with prednisolone appeared to be effective for the prevention of severe and continuous hypoglycemia.