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Journal article
Immunotherapy Induced Adrenal Insufficiency: An Underdiagnosed Cause of Persistent Hypotension in Cancer
Journal of community hospital internal medicine perspectives, v 14(4), pp 68-70
02 Jul 2024
PMID: 39391114
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Endocrinopathies following immunotherapy have infrequently been documented in the literature. Adrenal insufficiency is a rare consequence of pembrolizumab immunotherapy, with incidence reported to be between 0.98 and 1.3%. We present the case of a 34-year-old female with triple negative breast cancer on chemotherapy who presented with generalized weakness with tachycardia, tachypnea and hypotension unresponsive to fluids. Despite initial improvement with intravenous hydrocortisone and midodrine, the patient continued to be symptomatically hypotensive following discharge and required re-admission. AM cortisol level was found to be < 0.5 ug/dl and ACTH was < 1.5 pg/dL, consistent with secondary adrenal insufficiency. CT abdomen and pelvis was unremarkable for adrenal pathology. Patient had been initiated on pembrolizumab (Keytruda) 4 months prior to presentation as part of neoadjuvant chemotherapy. The patient was provided supportive treatment with discharge on fludrocortisone, prednisone, and midodrine. This case reports an unusual consequence of immune checkpoint inhibitors, in which early diagnostic testing, identification, and management is critical.
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Details
- Title
- Immunotherapy Induced Adrenal Insufficiency: An Underdiagnosed Cause of Persistent Hypotension in Cancer
- Creators
- Nina H. Cheng - Drexel UniversityHannah Lee - Drexel UniversityDivya Balchander - St. Vincent's Medical CenterRemy Mimms - University of California, IrvineMahesh Krishnamurthy - St. Luke's Hospital
- Publication Details
- Journal of community hospital internal medicine perspectives, v 14(4), pp 68-70
- Publisher
- DIGITAL COMMONS BEPRESS
- Number of pages
- 4
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate)
- Web of Science ID
- WOS:001263086800018
- Other Identifier
- 991021932789604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology