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Pembrolizumab-Induced Isolated Adrenocorticotropic Hormone (ACTH) Deficiency
Khalid Alfares1,2, Hye Jeong Han3
1Endocrinology, Diabetes and Metabolism, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.
Cureus
|February 14, 2024
Summary
Pembrolizumab immunotherapy can cause rare but serious secondary adrenal insufficiency. Early diagnosis and corticosteroid treatment are crucial for managing this rare side effect in cancer patients.
Area of Science:
- Immunotherapy
- Endocrinology
- Oncology
Background:
- Pembrolizumab is a programmed death 1 receptor (PD-1) inhibitor used in cancer immunotherapy.
- It is approved for metastatic melanoma, non-small cell lung cancer, and high-risk triple-negative breast cancer.
Observation:
- A 44-year-old female with triple-negative breast cancer developed poor oral intake and fatigue after pembrolizumab treatment.
- She was diagnosed with isolated secondary adrenal insufficiency (AI).
Findings:
- Pembrolizumab-induced secondary AI is a rare, potentially life-threatening complication.
- The patient's symptoms improved with corticosteroid treatment.
Implications:
- Clinicians should consider secondary AI in patients on pembrolizumab presenting with relevant symptoms.
- Borderline low initial cortisol levels warrant repeated testing to ensure timely diagnosis and management.
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