Isolated adrenocorticotropin deficiency induced by pembrolizumab for hypopharyngeal cancer: A case report

Yamamoto, Koichiro; Tokumasu, Kazuki; Oka, Kosuke; Hasegawa, Kou; Otsuka, Fumio

doi:10.1002/ccr3.4305

Cited by 4 publications

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Defects of the neurohypophysis are mainly reported in the context of pituitary metastasis [4]. Ascertainment of secondary adrenal failure used different testing strategies, including morning cortisol and ACTH [9,[11][12]15,[17][18][19][20][21][22][23][24][25][26][27], short Synacthen test [12,[16][17][18]21] and corticotropin-releasing hormone (CRH) stimulation test [12,16,24]. In our patient, three pituitary axes were affected: the adrenocorticotropic, thyroid and gonadotrophic axes.…”

Section: Hormonal Disturbancesmentioning

confidence: 98%

Exploring a New Entity of Single-Agent Pembrolizumab-Associated Hypophysitis

Balti¹,

Verhaeghe²,

Krüse³

et al. 2022

Cureus

View full text Add to dashboard Cite

Hypophysitis is the inflammation of the pituitary gland primary or secondary to local or systemic disease. It tends to occur more with cytotoxic T-lymphocyte-associated protein 4 inhibitors (10-15% of cases), which is a different entity compared to that associated with anti-program death 1 (anti-PD1) inhibitors. We describe a case of pembrolizumab-associated hypophysitis and conduct a systematic review of the literature.A 55-year-old woman with stage pT3aN1a (TNM stadium IIIb) melanoma presented with headache, nausea and fatigue three and a half months after starting pembrolizumab. Blood analyses revealed secondary adrenal failure, thyrotropic insufficiency and defective gonadotrophin secretion. An imaging study showed an enlarged pituitary gland with a homogeneous enhancement of the gland and pituitary stalk. Interruption of anti-PD1 therapy and administration of hormonal supplementation lead to clinical, biological and radiologic improvement after eight months.We identified 17 studies (20 patients) on single-agent pembrolizumab-associated hypophysitis. Patients were treated for melanoma (n=7; 33.3%), urogenital (n=5 ; 23.8%), lung (n=4 ; 19.0%), larynx (n=1 ; 4.8%), pharynx (n=1, 4.8%), breast (n=1, 4.8%) and colon (n=1, 4.8%) neoplasia. The time to onset of pituitary insufficiency was most frequently six months (range 1.5-39.0 months) after treatment initiation. The most prevalent hormonal defect was isolated adrenocorticotropic hormone (ACTH) deficiency. Four cases were reported with multiple central hormonal defects. In those patients, an enlarged pituitary gland was also observed.Our case has distinct features, including early disease onset after single-agent pembrolizumab initiation, panhypopituitarism and increased pituitary mass. These findings are in contrast with the majority of other cases of pembrolizumab-induced hypophysitis, as most patients present an isolated ACTH deficiency. Whether or not this is a new clinical entity warrants further investigation.

show abstract

Section: Hormonal Disturbancesmentioning

confidence: 98%

Exploring a New Entity of Single-Agent Pembrolizumab-Associated Hypophysitis

Balti¹,

Verhaeghe²,

Krüse³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

Pembrolizumab

2022

Reactions Weekly

View full text Add to dashboard Cite

Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report

Fujimiya,

Azuma,

Togashi

et al. 2024

J Pharm Health Care Sci

View full text Add to dashboard Cite

Background Pembrolizumab can cause immune-related adverse events such as adrenal insufficiency (AI). However, there is no consensus regarding appropriate monitoring of adrenal function during subsequent chemotherapy in patients who have received immune checkpoint inhibitors (ICIs) such as pembrolizumab. Case presentation In this report, we discuss the case of a 60s-year-old male patient with non-small cell lung cancer receiving chemotherapy who developed secondary AI due to adrenocorticotrophic hormone (ACTH) deficiency 8 months after the discontinuation of pembrolizumab, which was 17 months after the initiation of pembrolizumab immunotherapy. After 5 months of chemotherapy, he developed fever and diarrhoea, after which chemotherapy was discontinued. Thereafter, he was hospitalised owing to the development of general fatigue and anorexia. Although cortisol and ACTH levels were not measured during chemotherapy, they were measured before hospitalisation, and secondary AI was suspected. After admission, a detailed endocrine workup was performed, and the patient was diagnosed with secondary AI due to ACTH deficiency. Treatment with hydrocortisone was initiated, which markedly improved his general fatigue and anorexia. The patient showed no evidence of progressive disease 9 months after the discontinuation of pembrolizumab. Conclusions Although rare, the possibility of AI should be considered in patients who have received ICIs when nonspecific symptoms develop during or after subsequent chemotherapy, and measurements of endocrine function (including cortisol and ACTH levels) should be performed.

show abstract

Isolated adrenocorticotropin deficiency induced by pembrolizumab for hypopharyngeal cancer: A case report

Abstract: We report a case of isolated adrenocorticotropin deficiency caused by pembrolizumab. This condition can be fatal, but its rarity causes under‐recognition. Oncologists should pay attention to adrenal insufficiency due to pembrolizumab.

Cited by 4 publications

References 2 publications

Exploring a New Entity of Single-Agent Pembrolizumab-Associated Hypophysitis

Exploring a New Entity of Single-Agent Pembrolizumab-Associated Hypophysitis

Pembrolizumab

Pembrolizumab-induced secondary adrenal insufficiency due to adrenocorticotrophic hormone deficiency in a patient with non-small-cell lung carcinoma: a case report

Contact Info

Product

Resources

About