SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Pembrolizumab Induced Polyendocrinopathy

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This case report describes a 31-year-old woman with stage II breast cancer treated with chemotherapy and pembrolizumab, who presented to the emergency department with one day of nausea, vomiting, and generalized abdominal pain. She was found to have diabetic ketoacidosis, with marked hyperglycemia, elevated anion gap, and elevated beta-hydroxybutyrate. Additional testing showed very low C-peptide, elevated thyroid peroxidase antibodies, elevated TSH, and mildly elevated HbA1c, leading to diagnoses of type 1 diabetes mellitus and hypothyroidism. Pembrolizumab was stopped, and she was discharged on insulin and levothyroxine.<br /><br />During follow-up, she reported persistent fatigue. Further evaluation revealed a very low cortisol level, consistent with adrenal insufficiency. She was started on oral hydrocortisone, which significantly improved her symptoms.<br /><br />The authors highlight that pembrolizumab, a PD-1 immune checkpoint inhibitor, can trigger immune-related endocrine adverse events, including thyroid dysfunction, type 1 diabetes, hypophysitis, and adrenal insufficiency. Although these toxicities are often seen during treatment, this patient developed adrenal insufficiency weeks after pembrolizumab had already been discontinued, suggesting that immune effects may persist beyond therapy.<br /><br />The report concludes that clinicians should continue to monitor for endocrine complications even after immunotherapy is stopped, especially in patients who have already developed one immune-related endocrine adverse event.

Asset Subtitle

Muhammad Tayyeb

Meta Tag

Author List Aamir Shahzad, Farhan Khalid, Muhammad Asif, Muhammad Tayyeb, Trishala Meghal

Category Clinical Vignettes

Concept Pembrolizumab

Concept Endocrine Immune-Related Adverse Event

Concept Immune Checkpoint Inhibitor

Concept Type 1 Diabetes Mellitus

Concept Diabetic Ketoacidosis

Distinguished Non-Finalist

Presenter Organization Monmouth Medical Center

Presenting Author Muhammad Tayyeb

Track Adult

Keywords

pembrolizumab

immune checkpoint inhibitor

diabetic ketoacidosis

type 1 diabetes mellitus

hypothyroidism

adrenal insufficiency

endocrine adverse events

breast cancer

hydrocortisone

PD-1 immunotherapy

Pembrolizumab

Endocrine Immune-Related Adverse Event

Immune Checkpoint Inhibitor

Type 1 Diabetes Mellitus

Diabetic Ketoacidosis