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Secondary Adrenal Insufficiency and Multisystem Endocrinopathy Following Immune Checkpoint Inhibitor Therapy
1Department of Endocrinology, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai, UAE.
Annals of African Medicine
|July 31, 2026
Summary
Immune checkpoint inhibitors (ICIs) can cause endocrine issues like diabetes and adrenal insufficiency. Early diagnosis and hormone replacement are crucial for managing these immune-related adverse events (irAEs) in cancer patients.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, particularly for malignant melanoma.
- However, ICIs can trigger immune-related adverse events (irAEs), affecting various endocrine systems.
Purpose of the Study:
- To present a complex case of ICI-associated endocrinopathies.
- To highlight diagnostic and management challenges of these irAEs.
Main Methods:
- Case report of a 60-year-old male treated with ICIs.
- Detailed clinical presentation, treatment course, and diagnostic workup including pituitary MRI.
- Management with hormone replacement therapy.
Main Results:
- The patient developed insulin-dependent diabetes, eosinophilic asthma, and secondary adrenal insufficiency due to isolated ACTH deficiency.
- Pituitary MRI was normal, underscoring the challenge of diagnosing hypophysitis.
- Successful management with hydrocortisone, levothyroxine, and insulin therapy.
Conclusions:
- ICI-associated endocrinopathies, including hypophysitis and isolated ACTH deficiency, are increasingly common.
- A multidisciplinary approach is essential for managing these irAEs.
- Hormone replacement is key, and ICI therapy discontinuation is rarely necessary.
