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, vol.13, no.14, pp.1157-1164, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 13 Issue: 14
  • Publication Date: 2021
  • Doi Number: 10.2217/imt-2021-0061
  • Journal Name: IMMUNOTHERAPY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE, MEDLINE
  • Page Numbers: pp.1157-1164
  • Keywords: adrenocorticotropic hormone, cancer immunotherapy, endocrinopathy, hypophysitis, pancreatitis, pembrolizumab, IMMUNE-CHECKPOINT INHIBITORS, HYPOPHYSITIS, ENDOCRINE, FREQUENCY, SIGNAL
  • Hacettepe University Affiliated: Yes


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.