Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report.
Clinicians should consider the possibility of adrenal insufficiency in patients who have received immune checkpoint inhibitors like pembrolizumab, especially when nonspecific symptoms arise during or after chemotherapy.
Where it sits
this study against the rest of the ghrp-2 (pralmorelin) corpusSummary and findings
This case report discusses a 60s-year-old male patient with non-small cell lung cancer who developed secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency 8 months after discontinuing pembrolizumab, which was administered for 17 months. The patient experienced symptoms such as general fatigue and anorexia, leading to hospitalization and subsequent treatment with hydrocortisone, which improved his condition. No specific numeric outcomes were reported.
Abstract
<h4>Background</h4>Pembrolizumab can cause immune-related adverse events such as adrenal insufficiency (AI). However, there is no consensus regarding appropriate monitoring of adrenal function during subsequent chemotherapy in patients who have received immune checkpoint inhibitors (ICIs) such as pembrolizumab.<h4>Case presentation</h4>In this report, we discuss the case of a 60s-year-old male patient with non-small cell lung cancer receiving chemotherapy who developed secondary AI due to adrenocorticotrophic hormone (ACTH) deficiency 8 months after the discontinuation of pembrolizumab, which was 17 months after the initiation of pembrolizumab immunotherapy. After 5 months of chemotherapy, he developed fever and diarrhoea, after which chemotherapy was discontinued. Thereafter, he was hospitalised owing to the development of general fatigue and anorexia. Although cortisol and ACTH levels were not measured during chemotherapy, they were measured before hospitalisation, and secondary AI was suspected. After admission, a detailed endocrine workup was performed, and the patient was diagnosed with secondary AI due to ACTH deficiency. Treatment with hydrocortisone was initiated, which markedly improved his general fatigue and anorexia. The patient showed no evidence of progressive disease 9 months after the discontinuation of pembrolizumab.<h4>Conclusions</h4>Although rare, the possibility of AI should be considered in patients who have received ICIs when nonspecific symptoms develop during or after subsequent chemotherapy, and measurements of endocrine function (including cortisol and ACTH levels) should be performed.
Background
This paper addresses the clinical concern of secondary adrenal insufficiency in patients undergoing immunotherapy, specifically pembrolizumab, for non-small-cell lung carcinoma. Prior literature has noted the potential for adrenal insufficiency as an adverse effect of immunotherapy, but detailed case reports are necessary to understand the mechanisms and implications. This study is significant as it adds to the understanding of endocrine complications associated with cancer treatments.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Key findings
- Not reported in abstract.
Limitations
- Single case report limits generalizability.
- No numeric data provided.
- Lacks detailed methodology.