Progression of Hypopituitarism and Hypothyroidism after Treatment with Pembrolizumab in a Patient with Adrenal Metastasis from Non-small-cell Lung Cancer

• Published in: Internal Medicine Vol. 58; no. 24; pp. 3557 - 3562
• Main Authors: Yamagata, Satoshi, Kageyama, Kazunori, Takayasu, Shinobu, Asari, Yuko, Makita, Koshi, Terui, Ken, Daimon, Makoto
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.12.2019; Japan Science and Technology Agency
• Subjects: Adrenal Gland Neoplasms - drug therapy; Adrenal Gland Neoplasms - secondary; Adrenal glands; Adrenal Insufficiency - chemically induced; Adrenocorticotropic hormone; Adrenocorticotropic Hormone - deficiency; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - therapeutic use; Apoptosis; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - secondary; Case Report; Corticotropin-releasing hormone; Corticotropin-Releasing Hormone - analysis; Disease Progression; Humans; Hypopituitarism; Hypopituitarism - chemically induced; Hypothyroidism; Hypothyroidism - chemically induced; Immune checkpoint inhibitors; immune-related adverse events; Internal medicine; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Male; Metastases; Metastasis; Monoclonal antibodies; Non-small cell lung carcinoma; Pembrolizumab; Pituitary; Targeted cancer therapy; pembrolizumab; hypopituitarism; hypothyroidism; immune-related adverse events
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3008-19

Pembrolizumab, or anti-programmed death receptor 1 antibody, is an immune checkpoint inhibitor that can cause immune-related adverse events. We herein report for the first time the progression of hypopituitarism and hypothyroidism after treatment with pembrolizumab in a patient with adrenal metastasis of non-small-cell lung cancer. Severe primary hypothyroidism occurred three weeks after the first administration of pembrolizumab. Four months after the discontinuation of pembrolizumab, isolated adrenocorticotropic hormone (ACTH) deficiency was noted. Corticotropin-releasing hormone and rapid ACTH tests performed repeatedly showed that the patient's pituitary and adrenal function had been gradually deteriorating. It is important to diagnose adrenal insufficiency without delay in order to prevent adrenal crisis.