SHM Converge Scientific Abstract ePoster Gallery-Pembrolizumab-Induced Adrenal Insuccifiency Diagnosed in a Dedicated Preoperative Medicine Clinic

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This poster presents a case of pembrolizumab-induced adrenal insufficiency identified in a dedicated preoperative medicine clinic. A 69-year-old man was referred before cystoprostatectomy for bladder cancer that had responded well to pembrolizumab. His medical history included rare supraventricular tachycardia, anemia, hypothyroidism, and a prior right common femoral vein DVT treated with apixaban. He recently developed syncope, fatigue, and generalized weakness.<br /><br />The poster emphasizes that syncope and fatigue in the preoperative setting have broad differentials, but clinicians should prioritize causes that increase perioperative risk, including heart failure, valvular disease, arrhythmia, pulmonary embolism, hypovolemia, hypoglycemia, anemia, thyroid disease, sleep apnea, frailty, and deconditioning. Because pembrolizumab can cause adrenal insufficiency, often through hypophysitis, it should also be considered when symptoms are nonspecific.<br /><br />Pembrolizumab-induced adrenal insufficiency is uncommon but clinically important. Reported incidence is about 0.98%, though one study found rates as high as 5.4%. It is frequently missed until patients become critically ill. Importantly, it can occur at any time during treatment and may even present months after therapy has ended. While oncology screening protocols exist, there is little perioperative-specific guidance beyond maintaining a low threshold for suspicion in symptomatic patients.<br /><br />The main takeaway is that perioperative clinicians should actively consider immune checkpoint inhibitor–related adrenal insufficiency in patients treated with pembrolizumab, especially when they present with nonspecific symptoms such as syncope, fatigue, or weakness. Early recognition in the preoperative clinic may prevent missed diagnosis and reduce perioperative risk.

Asset Subtitle

Avital O'Glasser

Meta Tag

Author List Angela Kitzerow, Avital O'Glasser, Jonathan Soffer

Category Clinical Vignettes

Concept Pembrolizumab

Concept Adrenal Insufficiency

Concept Hypophysitis

Concept Immune Checkpoint Inhibitor

Concept Syncope

Distinguished Non-Finalist

Presenter Organization Ohsu

Presenting Author Avital O'Glasser

Track Adult

Keywords

pembrolizumab

adrenal insufficiency

preoperative medicine

syncope

fatigue

immune checkpoint inhibitor

hypophysitis

bladder cancer

perioperative risk

cystoprostatectomy

Pembrolizumab

Adrenal Insufficiency

Hypophysitis

Immune Checkpoint Inhibitor

Syncope