case_images: PMC7358340_01
case_images: Morning cortisol levels throughout treatment. K', start of Q5 Ketoconazole treatment; E, intravenous Etomidate; T, transsternal thymectomy; K", Restart of Ketoconazole with both Mifepristone (Mi) and Pasireotide (P). Due to not satisfying response, E was restarted and chemotherapy with Cisplatin and Etoposide (C/E) began. Me, Metopirone treatment; K"', Replacement of E by Ketoconazole. PRE, FU1, and FU2 indicate the timepoints of the immunological measurements.
case_images: fimmu-11-01435-g0001.jpg
case_images: PMC7358340_01_fimmu-11-01435-g0001.jpg
case_images: F1
case_images: The progression of morning cortisol levels under the different therapies is shown in Figure 1.
case_images: Serum immunoglobulin concentrations and lymphocyte (sub)populations compared to morning cortisol levels during cortisol lowering treatment. PRE, first measurement before starting Ketoconazole treatment; FU1, second measurement 12 days after the surgical removal of the thymic tumor/start of chemotherapy with Cisplatin/Etoposide; FU2, third measurement 15 days later and 27 days after thymectomy with cortisol levels being in the normal range. FU3, fourth measurement 321 days after first measurement and after undergoing chemotherapy, radiotherapy, and during radiopeptide therapy.
case_images: fimmu-11-01435-g0002.jpg
case_images: PMC7358340_01_fimmu-11-01435-g0002.jpg
case_images: F2
case_images: IgG subclasses as well as quantification of lymphocyte populations and B cell subpopulations were performed. Immunological alterations were compared to endogenous morning cortisol levels as determined during the monitoring of cortisol lowering treatment (Figure 2).