SHM Converge Scientific Abstract ePoster Gallery-Opdivo Induced Secondary Adrenal Insufficiency: A Mimicker of Sepsis

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This case describes a 43-year-old woman with gastric adenocarcinoma and Krukenberg tumor who had been treated with FOLFOX and nivolumab (Opdivo). She presented with dysuria, generalized pain, fever, and hypotension, and was initially managed for possible sepsis with IV fluids, antibiotics, and later stress-dose steroids. Despite treatment, cultures were negative and the infectious workup remained unrevealing, while she continued to have recurrent hypotension, weakness, fatigue, nausea, and dizziness.<br /><br />Further evaluation showed findings consistent with secondary adrenal insufficiency: low cortisol, poor response to cosyntropin stimulation, and low ACTH, suggesting adrenal suppression likely related to nivolumab-induced hypophysitis or other immune-related endocrine toxicity. Her symptoms improved significantly after starting hydrocortisone 10 mg twice daily.<br /><br />The report emphasizes that immune checkpoint inhibitors such as nivolumab can cause serious immune-related adverse events, including secondary adrenal insufficiency. Because symptoms like fatigue, dizziness, nausea, and weakness are nonspecific and can resemble sepsis or routine cancer-treatment side effects, diagnosis may be delayed. This can lead to unnecessary antibiotics, testing, and potentially life-threatening hypotension.<br /><br />The authors highlight the importance of considering adrenal insufficiency in patients receiving immune checkpoint inhibitors, especially when recurrent hypotension is unexplained. Monitoring with ACTH and cortisol testing may help identify cases earlier. Early recognition and prompt steroid replacement are essential to prevent severe complications and improve patient outcomes.

Asset Subtitle

Prekchha Jha

Meta Tag

Author List Melinda Sager, Prekchha Jha, Tawhida Khatoon

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor

Concept Nivolumab

Concept Immune-Related Adverse Event

Concept Secondary Adrenal Insufficiency

Concept Cortisol

Distinguished Non-Finalist

Presenter Organization Corewell Health William Beaumont University Hospital, Royal Oak, MI

Presenting Author Prekchha Jha

Track Adult

Keywords

gastric adenocarcinoma

Krukenberg tumor

nivolumab

immune checkpoint inhibitor

secondary adrenal insufficiency

hypophysitis

hypotension

cosyntropin stimulation test

hydrocortisone

immune-related adverse event

Immune Checkpoint Inhibitor

Nivolumab

Immune-Related Adverse Event

Secondary Adrenal Insufficiency

Cortisol