Clinical course and management of pembrolizumab-associated isolated adrenocorticotrophic hormone deficiency: a new case and literature review

Oguz S. H., ÜNLÜTÜRK U., AKSOY S., Erbas T.

IMMUNOTHERAPY, cilt.13, sa.14, ss.1157-1164, 2021 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 13 Sayı: 14
  • Basım Tarihi: 2021
  • Doi Numarası: 10.2217/imt-2021-0061
  • Dergi Adı: IMMUNOTHERAPY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.1157-1164
  • Anahtar Kelimeler: adrenocorticotropic hormone, cancer immunotherapy, endocrinopathy, hypophysitis, pancreatitis, pembrolizumab, IMMUNE-CHECKPOINT INHIBITORS, HYPOPHYSITIS, ENDOCRINE, FREQUENCY, SIGNAL
  • Hacettepe Üniversitesi Adresli: Evet

Özet

Hypophysitis is rarely reported in patients receiving pembrolizumab-only immunotherapies. Since the clinical presentation is usually as isolated adrenocorticotrophic hormone (ACTH) deficiency, patients may be misjudged as having clinical symptoms due to cancer or chemotherapy. A 49-year-old male with laryngeal cancer applied to our clinic just after the tenth cycle of his pembrolizumab treatment, with weakness and nausea/vomiting. Serum morning cortisol and ACTH were 0.47 mcg/dl and 10.1 pg/ml, respectively; the remaining anterior pituitary hormone levels were normal. Pituitary MRI revealed mild glandular enlargement and loss of posterior pituitary bright-spot. All symptoms and signs improved with low-dose prednisolone. This is the second reported case of pembolizumab-associated isolated ACTH deficiency having abnormal pituitary MRI findings as we have reviewed all reported cases in the literature.