[A Case of Isolated ACTH Deficiency Induced by Nivolumab in a Patient with Gastric Cancer Metastasis of the Peritoneum].

Nivolumab induces several immune-related adverse events. Isolated adrenocorticotropic hormone(ACTH)deficiency has low frequency. A 73-year-old woman with gastric cancer metastasis of the peritoneum was treated with nivolumab as the third-line chemotherapy. After 5 courses of nivolumab, she developed hypothyroidism. After completing 12 courses, peritoneal metastasis increased. We evaluated the metastasis as progression of disease, so treatment with nivolumab was discontinued. Two weeks after the last dosage of nivolumab, she developed general fatigue and appetite loss. At first, we considered that these symptoms were caused by peritoneal metastasis, but progression was not indicated in the CT. Blood levels of cortisol and ACTH were very low. We suspected secondary adrenocortical insufficiency induced by nivolumab. Endocrinological examinations and the results of brain MRIsuggested isolated ACTH deficiency. This is the first report of isolated ACTH deficiency induced by nivolumab in a patient with gastric cancer metastasis of the peritoneum. The symptoms of adrenocortical insufficiency induced by nivolumab overlap with those of peritoneal metastasis, and thus, it may be difficult to confirm a differential diagnosis. When adrenocortical insufficiency is suspected, we should check the blood levels of cortisol and ACTH.

Varietal difference in vitamin C content in the fruit of kiwifruit and other actinidia species.

Vitamin C content in the fruit of various cultivars of kiwifruit and other Actinidia species was estimated by determination of L-ascorbic acid and L-dehydroascorbic acid using ion-pair reversed-phase high-performance liquid chromatography. Fruit of A. deliciosa cv. Hayward, the most common commercially available cultivar, contained 65.5 mg/100 g fresh weight (FW) vitamin C. Vitamin C content in A. deliciosa fruit varied from 29 mg/100 g FW to 80 mg/100 g FW. In most cultivars of A. chinensis, vitamin C content in fruit was higher than that of Hayward. In particular, vitamin C content in cv. Sanuki Gold fruit reached more than 3-fold that of Hayward on a weight for weight basis. In A. argutafruit, there was wide variation in vitamin C content, with concentrations ranging from 37 to 185 mg/100 g FW. In cv. Gassan, Issai, and Mitsuko, vitamin C content of the fruit was much higher than that of Hayward. In A. arguta fruit, the ratio of L-ascorbic acid to total ascorbic acid tended to be higher than that of other species.