Adverse Endocrine-Related Effects of Pembrolizumab Precipitating Severe Hyponatremia

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Pembrolizumab is a humanized monoclonal antibody targeting the PD-1 receptor, acting as an immune-checkpoint inhibitor.
• Immune-checkpoint inhibitors (ICIs) like pembrolizumab can reverse T cell suppression, enhancing anti-tumor responses.
• Adverse endocrine effects, including hypothyroidism and secondary adrenal insufficiency, are known complications of ICI therapy.

Observation:

• A 53-year-old woman with metastatic melanoma was treated with pembrolizumab.
• The patient developed severe hyponatremia.
• The hyponatremia was suspected to be linked to endocrine-related side effects of pembrolizumab therapy.

Findings:

• Pembrolizumab treatment was associated with endocrine dysfunction.
• Hypothyroidism and secondary adrenal insufficiency are potential side effects of pembrolizumab.
• These endocrine issues can independently contribute to hyponatremia.

Implications:

• Severe hyponatremia can be precipitated by pembrolizumab-induced endocrine adverse events.
• Clinicians should monitor for endocrine dysfunction and electrolyte imbalances in patients receiving pembrolizumab.
• Early recognition and management of these side effects are crucial for patient safety and treatment efficacy.