SHM Converge Scientific Abstract ePoster Gallery-Pembrolizumab Induced Isolated Acth Deficiency

Pdf Summary

This case report describes a 71-year-old man with stage IIIA lung cancer treated with pembrolizumab who developed fatigue, hypotension, and hyponatremia after two weeks of symptoms. Workup showed very low cortisol, low ACTH, and an inadequate ACTH stimulation response, consistent with secondary adrenal insufficiency due to isolated ACTH deficiency. Other pituitary hormones were normal, and MRI of the pituitary showed no evidence of hypophysitis. CT imaging also showed normal adrenal glands, supporting a central rather than primary adrenal cause.<br /><br />Pembrolizumab is an immune checkpoint inhibitor used effectively in advanced non-small cell lung cancer, but it can cause immune-related adverse events, including endocrine disorders such as thyroid dysfunction, hypophysitis, and adrenal insufficiency. Isolated ACTH deficiency is rare but important because it may present with nonspecific symptoms such as fatigue, weakness, nausea, and orthostatic hypotension.<br /><br />The patient improved after intravenous hydrocortisone, later transitioned to oral physiologic replacement, with normalization of blood pressure and sodium levels and resolution of fatigue. The report emphasizes the need for clinicians to remain alert for endocrine toxicity in patients receiving pembrolizumab, especially when symptoms and laboratory findings suggest adrenal insufficiency even if pituitary imaging is normal.

Asset Subtitle

Michael H. Basir

Meta Tag

Author List Ahmad Alqam, Jason D. Lofters, Michael H. Basir, Ross Lavine, Sofia Terner, Zachary Banbury

Category Clinical Vignettes

Concept Pembrolizumab

Concept Adrenal Insufficiency

Concept Immune Checkpoint Inhibitor

Concept Endocrine Immune-Related Adverse Event

Concept Isolated ACTH Deficiency

Distinguished Non-Finalist

Presenter Organization Englewood Health

Presenting Author Michael H. Basir

Track Adult

Keywords

pembrolizumab

lung cancer

secondary adrenal insufficiency

isolated ACTH deficiency

immune checkpoint inhibitor

hypotension

hyponatremia

hydrocortisone

hypophysitis

endocrine toxicity

Pembrolizumab

Adrenal Insufficiency

Immune Checkpoint Inhibitor

Endocrine Immune-Related Adverse Event

Isolated ACTH Deficiency