Kafley Shashwat, Tamrakar Silbin, Samra Mohammed, Shanmugar Suriya, Gupta Isha
General Practice, Enam Medical College and Hospital, Dhaka, BGD.
Internal Medicine, University of Debrecen, Debrecen, HUN.
Cureus. 2024 Sep 24;16(9):e70089. doi: 10.7759/cureus.70089. eCollection 2024 Sep.
Immune checkpoint inhibitors, such as pembrolizumab, have transformed cancer therapy by enhancing the immune system's ability to combat tumors, but they can also lead to immune-related adverse events, including adrenal insufficiency. This case report presents a 52-year-old male with a history of malignant melanoma who developed adrenal insufficiency after four months of pembrolizumab therapy. The patient was admitted with symptoms of malaise, vomiting, abdominal pain, and poor appetite. Laboratory tests revealed significant metabolic abnormalities including hyponatremia, hypokalemia, and elevated thyroid-stimulating hormone. Further endocrine evaluation confirmed the diagnosis of secondary adrenal insufficiency, likely due to pembrolizumab-induced inflammation of the pituitary gland. The patient was treated with corticosteroid replacement therapy, leading to clinical improvement, and pembrolizumab was discontinued due to the risk of worsening adrenal insufficiency. This case underscores the importance of early recognition and management of adrenal insufficiency in patients receiving pembrolizumab. While the exact cause of pembrolizumab-induced adrenal insufficiency is not fully understood, it may involve an autoimmune attack on cells in the pituitary gland. Prompt identification and treatment are essential to prevent potentially life-threatening complications, and this case highlights the need for clinicians to maintain a high level of awareness for adrenal insufficiency in patients presenting with nonspecific symptoms during or after immunotherapy.
免疫检查点抑制剂，如帕博利珠单抗，通过增强免疫系统对抗肿瘤的能力改变了癌症治疗方式，但它们也可能导致免疫相关不良事件，包括肾上腺功能不全。本病例报告介绍了一名52岁男性，有恶性黑色素瘤病史，在接受帕博利珠单抗治疗四个月后出现肾上腺功能不全。患者因全身不适、呕吐、腹痛和食欲不振症状入院。实验室检查发现显著的代谢异常，包括低钠血症、低钾血症和促甲状腺激素升高。进一步的内分泌评估确诊为继发性肾上腺功能不全，可能是由于帕博利珠单抗引起的垂体炎症。患者接受了皮质类固醇替代治疗，临床症状改善，由于肾上腺功能不全恶化风险，停用了帕博利珠单抗。本病例强调了在接受帕博利珠单抗治疗的患者中早期识别和管理肾上腺功能不全的重要性。虽然帕博利珠单抗引起肾上腺功能不全的确切原因尚未完全了解，但可能涉及对垂体细胞的自身免疫攻击。及时识别和治疗对于预防潜在的危及生命的并发症至关重要，本病例突出了临床医生在免疫治疗期间或之后对出现非特异性症状的患者肾上腺功能不全保持高度警惕的必要性。
