SHM Converge Scientific Abstract ePoster Gallery-A Case of Profound Fatigue in a Patient With Lung Adenocarcinoma on Chemotherapy

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This case describes a 71-year-old man with lung adenocarcinoma who developed 1 week of progressive fatigue and weakness shortly after receiving carboplatin, pemetrexed, and pembrolizumab. Although he initially blamed the symptoms on chemotherapy, evaluation showed significant endocrine abnormalities: marked hypothyroidism with elevated TSH, low free T4, positive thyroglobulin antibodies, and impaired cortisol response on ACTH stimulation testing. These findings supported a diagnosis of primary hypothyroidism and primary adrenal insufficiency.<br /><br />The patient was treated with hydrocortisone, fludrocortisone, and levothyroxine, leading to substantial improvement in symptoms and discharge home on stable replacement therapy. <br /><br />The report highlights the importance of considering immune checkpoint inhibitor (ICI)-related endocrinopathies in patients receiving pembrolizumab. ICIs can cause several endocrine complications, including thyroid dysfunction, hypopituitarism, adrenal insufficiency, and type 1 diabetes. Adrenal insufficiency from ICIs is more commonly secondary to hypopituitarism, making this patient’s primary adrenal insufficiency a rarer presentation. His elevated TSH and abnormal ACTH stimulation test made secondary adrenal insufficiency less likely.<br /><br />Overall, the case emphasizes that nonspecific symptoms such as fatigue and weakness in cancer patients may reflect serious immune-related adverse effects rather than chemotherapy-related side effects alone. Early recognition and prompt treatment are essential to prevent morbidity, preserve quality of life, and avoid more severe complications.

Asset Subtitle

Rafae Alam

Meta Tag

Author List Hayalneh Gessessew, Maya Patel, Michael Gallagher, Rafae Alam

Category Clinical Vignettes

Concept Adrenal Insufficiency

Concept Immune Checkpoint Inhibitor

Concept Endocrinopathy

Concept Hypopituitarism

Concept Primary Adrenal Insufficiency

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine, Atlanta, GA, United States

Presenting Author Rafae Alam

Track Adult

Keywords

pembrolizumab

immune checkpoint inhibitor

primary hypothyroidism

primary adrenal insufficiency

lung adenocarcinoma

fatigue

weakness

thyroid dysfunction

ACTH stimulation test

endocrinopathy

Adrenal Insufficiency

Immune Checkpoint Inhibitor

Endocrinopathy

Hypopituitarism

Primary Adrenal Insufficiency