Immunotherapy induced adrenal insufficiency: an underdiagnosed cause of persistent hypotension in cancer

Authors

Nina H. Cheng, Drexel University College of Medicine, Philadelphia, PA, USAFollow
Hannah Lee, Drexel University College of Medicine, Philadelphia, PA, USA
Divya Balchander, Department of Endocrinology, St. Luke’s Hospital, Monroe, PA, USA
Remy Mimms, Department of Medicine, University of California Irvine, Irvine, CA, USA
Mahesh Krishnamurthy, Department of Medicine, St. Luke’s Hospital, Monroe, PA, USA

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

Recommended Citation

H. Cheng, Nina; Lee, Hannah; Balchander, Divya; Mimms, Remy; and Krishnamurthy, Mahesh (2024) "Immunotherapy induced adrenal insufficiency: an underdiagnosed cause of persistent hypotension in cancer," Journal of Community Hospital Internal Medicine Perspectives: Vol. 14: Iss. 4, Article 14.
DOI: 10.55729/2000-9666.1375
Available at: https://scholarlycommons.gbmc.org/jchimp/vol14/iss4/14