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Background <p>Immune checkpoint inhibitor (ICI)-induced diabetes is a rare endocrine immune-related adverse event, and long-term pancreatic magnetic resonance imaging (MRI) findings after disease onset have not been well characterized.</p> Case presentation <p>An individual developed abrupt hyperglycemia during pembrolizumab therapy for recurrent renal cell carcinoma and subsequently required insulin therapy. Serum C-peptide rapidly declined to below the detection threshold, whereas pancreatic enzyme levels remained within normal limits throughout follow-up. MRI performed 1 day after diagnosis demonstrated diffuse high signal intensity on diffusion-weighted imaging (DWI) and reduced apparent diffusion coefficient (ADC) values throughout the pancreas. Serial imaging over 25 months showed progressive pancreatic atrophy, whereas the DWI/ADC features persisted.</p> Conclusion <p>This case provides a new descriptive longitudinal radiological observation of persistent diffusion-related pancreatic MRI findings and progressive pancreatic atrophy after the onset of ICI-induced diabetes.</p>

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Long-term imaging characteristics of the pancreas related to diabetes induced by immune checkpoint inhibitor therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月26日

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  • Seiji Tomofuji,
  • Shin Urai,
  • Kei Yoshino,
  • Hironori Bando,
  • Yushi Hirota

摘要

Background

Immune checkpoint inhibitor (ICI)-induced diabetes is a rare endocrine immune-related adverse event, and long-term pancreatic magnetic resonance imaging (MRI) findings after disease onset have not been well characterized.

Case presentation

An individual developed abrupt hyperglycemia during pembrolizumab therapy for recurrent renal cell carcinoma and subsequently required insulin therapy. Serum C-peptide rapidly declined to below the detection threshold, whereas pancreatic enzyme levels remained within normal limits throughout follow-up. MRI performed 1 day after diagnosis demonstrated diffuse high signal intensity on diffusion-weighted imaging (DWI) and reduced apparent diffusion coefficient (ADC) values throughout the pancreas. Serial imaging over 25 months showed progressive pancreatic atrophy, whereas the DWI/ADC features persisted.

Conclusion

This case provides a new descriptive longitudinal radiological observation of persistent diffusion-related pancreatic MRI findings and progressive pancreatic atrophy after the onset of ICI-induced diabetes.